Healthcare Provider Details

I. General information

NPI: 1164345575
Provider Name (Legal Business Name): THERAVENTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE B
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

2976 E. STATE ST. STE 120 PMB 2941
EAGLE ID
83616-6394
US

V. Phone/Fax

Practice location:
  • Phone: 208-972-0354
  • Fax:
Mailing address:
  • Phone: 208-972-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: YISKA FOREST HUGO
Title or Position: OWNER
Credential: LCSW
Phone: 208-972-0354