Healthcare Provider Details

I. General information

NPI: 1801035878
Provider Name (Legal Business Name): ALBENI-SELKIRK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ALBENI RD. STE. B
PRIEST RIVER ID
83856
US

IV. Provider business mailing address

5914 RAPID LIGHTNING RD
SANDPOINT ID
83864-7948
US

V. Phone/Fax

Practice location:
  • Phone: 208-290-2771
  • Fax:
Mailing address:
  • Phone: 208-290-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLCSW-25601
License Number StateID

VIII. Authorized Official

Name: WILLIAM TAGGART KENT
Title or Position: OWNER
Credential: LCSW
Phone: 208-290-2771