=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043007412
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLOSE THE GAP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2025
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 E WARM SPRINGS AVE STE F
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83712-6457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-918-0953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 E WARM SPRINGS AVE STE F
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83712-6457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-918-0953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MENTAL HEALTH COUNSELOR
-----------------------------------------------------
Name | DANIELLE JACQUELINE SHEDDEN
-----------------------------------------------------
Credential | MS, LPC, NCC
-----------------------------------------------------
Telephone | 208-918-0953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------