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General NPI Number Information
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NPI Number | 1427813658
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Entity Type | Organization
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Legal Business Name | BODHICITTA COUNSELING LLC
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Dates
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Enumeration Date | 02/16/2024
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 250 NORTHWEST BLVD
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2974
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Country | US
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Telephone | 208-929-6845
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Fax |
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Provider Business Mailing Address
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Address Line | 9030 N HESS ST # 104
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City | HAYDEN
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State | ID
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Zip | 83835-9827
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREG LIPPERT
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Credential | LCPC
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Telephone | 208-929-6845
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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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