Healthcare Provider Details

I. General information

NPI: 1326951591
Provider Name (Legal Business Name): FEARLESS MENTAL HEALTH CLUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E SELTICE WAY STE 208
POST FALLS ID
83854-7638
US

IV. Provider business mailing address

13291 W BIGGS RD
RATHDRUM ID
83858-8755
US

V. Phone/Fax

Practice location:
  • Phone: 208-247-4727
  • Fax:
Mailing address:
  • Phone: 202-247-4727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHAUNA RAE STIMMEL
Title or Position: OWNER/COUNSELOR
Credential: LPC
Phone: 208-247-4727