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General NPI Number Information
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NPI Number | 1427179746
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Entity Type | Organization
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Legal Business Name | SANDPOINT PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 506 N 4TH AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1513
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Country | US
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Telephone | 208-263-5393
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Fax | 208-265-2301
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Provider Business Mailing Address
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Address Line | 506 N 4TH AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1513
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Country | US
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Telephone | 208-263-5393
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Fax | 208-265-2301
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Authorized Official
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Title or Position | OWNER AND LEAD CLINICIAN
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Name | MS. ELEANOR RAND GURELY
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Credential | LCSW,DAPA
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Telephone | 208-263-5393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW-1358
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License Number State | ID
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