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General NPI Number Information
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NPI Number | 1184927873
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Entity Type | Organization
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Legal Business Name | REMEDY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 12/18/2010
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Last Update Date | 12/18/2010
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Provider Practice Location Address
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Address Line | 750 W USTICK RD STE 120
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City | MERIDIAN
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State | ID
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Zip | 83646-6133
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Country | US
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Telephone | 208-340-4181
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Fax |
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Provider Business Mailing Address
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Address Line | 475 N LYNGATE PL
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City | STAR
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State | ID
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Zip | 83669-5073
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Country | US
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Telephone | 208-340-4181
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Fax |
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Authorized Official
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Title or Position | CLINCIAL DIRECTOR/OWNER
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Name | MRS. MELANIE T TWITE
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Credential | MA
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Telephone | 208-340-4181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC 4339
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License Number State | ID
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