Healthcare Provider Details

I. General information

NPI: 1073446480
Provider Name (Legal Business Name): HAWTHORN HEALING COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 S YELLOWSTONE HWY STE 203
REXBURG ID
83440-5294
US

IV. Provider business mailing address

859 S YELLOWSTONE HWY STE 203
REXBURG ID
83440-5294
US

V. Phone/Fax

Practice location:
  • Phone: 208-269-6980
  • Fax: 208-254-5205
Mailing address:
  • Phone: 208-269-6980
  • Fax: 208-254-5205

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: SAMANTHA GREGSTON
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 208-269-6980