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General NPI Number Information
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NPI Number | 1477013191
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Entity Type | Organization
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Legal Business Name | INTENSIVE HEALING THERAPY, LLC.
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | 10424 DUCK LN
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City | NAMPA
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State | ID
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Zip | 83686-9174
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Country | US
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Telephone | 208-280-0576
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Fax |
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Provider Business Mailing Address
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Address Line | 10424 DUCK LN
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City | NAMPA
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State | ID
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Zip | 83686-9174
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Country | US
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Telephone | 208-280-0576
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Fax | 855-898-8002
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOHNNY URRUTIA
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Credential | EQUINE SPECIALIST
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Telephone | 208-280-0576
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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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