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General NPI Number Information
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NPI Number | 1235093196
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Entity Type | Organization
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Legal Business Name | CORYLUS CARE LLC
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 250 MAIN AVE N STE B
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City | TWIN FALLS
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State | ID
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Zip | 83301-6102
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Country | US
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Telephone | 913-558-5194
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Fax |
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Provider Business Mailing Address
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Address Line | 1508 MAPLE AVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-6641
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Country | US
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Telephone | 913-558-5194
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Fax |
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Authorized Official
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Title or Position | COUNSELOR / OWNER
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Name | MICHAEL HAZEL
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Credential | LPC
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Telephone | 913-558-5194
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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 |
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License Number State |
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