Healthcare Provider Details

I. General information

NPI: 1063343721
Provider Name (Legal Business Name): MBS THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13867 W HIGHWAY 53 UNIT 605
RATHDRUM ID
83858-4025
US

IV. Provider business mailing address

PO BOX 605
RATHDRUM ID
83858-0605
US

V. Phone/Fax

Practice location:
  • Phone: 559-999-1054
  • Fax:
Mailing address:
  • Phone: 559-999-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARISSA B SHENNAN
Title or Position: OWNER
Credential: LMFT
Phone: 559-999-1054