Healthcare Provider Details

I. General information

NPI: 1770105850
Provider Name (Legal Business Name): BIGFOOT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 S CLEARWATER LOOP STE B
POST FALLS ID
83854-5437
US

IV. Provider business mailing address

570 S CLEARWATER LOOP STE B
POST FALLS ID
83854-5437
US

V. Phone/Fax

Practice location:
  • Phone: 208-777-2169
  • Fax: 208-777-2189
Mailing address:
  • Phone: 208-777-2169
  • Fax: 208-777-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW TYSON HANSEN
Title or Position: OWNER
Credential:
Phone: 208-777-2169