Healthcare Provider Details

I. General information

NPI: 1053997197
Provider Name (Legal Business Name): SAINT MARIES COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N 8TH ST STE 4
SAINT MARIES ID
83861-1869
US

IV. Provider business mailing address

201 N 8TH ST STE 4
SAINT MARIES ID
83861-1869
US

V. Phone/Fax

Practice location:
  • Phone: 208-597-7639
  • Fax: 208-717-9450
Mailing address:
  • Phone: 208-597-7639
  • Fax: 208-717-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA ROBINSON
Title or Position: MEMBER
Credential: LAMFT
Phone: 208-582-4202