Healthcare Provider Details

I. General information

NPI: 1205773124
Provider Name (Legal Business Name): WHOLEHEARTED JOURNEY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PINE ST STE A
SANDPOINT ID
83864-1682
US

IV. Provider business mailing address

PO BOX 271
SAGLE ID
83860-0271
US

V. Phone/Fax

Practice location:
  • Phone: 208-290-6604
  • Fax:
Mailing address:
  • Phone: 208-290-6604
  • Fax: 208-216-8055

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: AMBER RENEE HENRICKSON
Title or Position: OWNER
Credential: LCSW
Phone: 208-290-6604