Healthcare Provider Details

I. General information

NPI: 1245126358
Provider Name (Legal Business Name): PHOENIX THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SELTICE WAY STE 6B
POST FALLS ID
83854-5337
US

IV. Provider business mailing address

1869 E SELTICE WAY # 514
POST FALLS ID
83854-7019
US

V. Phone/Fax

Practice location:
  • Phone: 509-723-7122
  • Fax: 509-723-7122
Mailing address:
  • Phone: 509-723-7122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA LENNARTZ
Title or Position: OWNER
Credential: LPC 3932
Phone: 509-723-7122