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General NPI Number Information
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NPI Number | 1437882123
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Entity Type | Organization
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Legal Business Name | WILD HEART LIVING
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 1005 E PARK BLVD
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City | BOISE
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State | ID
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Zip | 83712-7722
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Country | US
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Telephone | 208-505-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 E PARK BLVD
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City | BOISE
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State | ID
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Zip | 83712-7722
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Country | US
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Telephone | 208-505-7300
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOTHERAPIST
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Name | SHEILA DIANE CHAPDELAINE
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Credential | LCSW
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Telephone | 208-515-7588
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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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