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General NPI Number Information
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NPI Number | 1316649106
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Entity Type | Organization
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Legal Business Name | IDAHO COUNSELING AND TRAUMA CENTER
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Dates
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Enumeration Date | 03/17/2023
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 1309 PONDEROSA DR
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City | SANDPOINT
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State | ID
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Zip | 83864-8278
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Country | US
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Telephone | 208-278-6027
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Fax |
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Provider Business Mailing Address
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Address Line | 204 N 4TH AVE UNIT 2423
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City | SANDPOINT
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State | ID
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Zip | 83864-0476
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Country | US
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Telephone | 208-278-6027
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAMARA K BAKER
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Credential | LMFT
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Telephone | 208-278-6027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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