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General NPI Number Information
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NPI Number | 1417158338
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH COUNSELING LLC
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 2707 GARRITY BLVD STE 5
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City | NAMPA
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State | ID
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Zip | 83687-3679
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Country | US
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Telephone | 208-466-7443
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Fax | 208-466-5058
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Provider Business Mailing Address
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Address Line | 2707 GARRITY BLVD STE 5
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City | NAMPA
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State | ID
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Zip | 83687-3679
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Country | US
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Telephone | 208-466-7443
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Fax | 208-466-5058
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Authorized Official
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Title or Position | OWNER
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Name | PAULA S. MARCOTTE
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Credential | LMSW
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Telephone | 208-466-7443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 26327
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License Number State | ID
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Taxonomy #2
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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 | 26327
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License Number State | ID
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