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General NPI Number Information
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NPI Number | 1457360711
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Entity Type | Organization
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Legal Business Name | LIFE SOLUTIONS INC.
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 11/20/2008
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Provider Practice Location Address
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Address Line | 6003 W OVERLAND RD SUITE 101
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City | BOISE
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State | ID
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Zip | 83709-3073
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Country | US
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Telephone | 208-322-7699
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Fax | 208-345-2077
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Provider Business Mailing Address
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Address Line | 6003 W OVERLAND RD SUITE 101
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City | BOISE
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State | ID
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Zip | 83709-3073
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Country | US
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Telephone | 208-322-7699
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Fax | 208-345-2077
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | WENDY E. BARTH
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Credential | LCSW
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Telephone | 208-322-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW 1232
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License Number State | ID
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