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General NPI Number Information
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NPI Number | 1477061299
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Entity Type | Organization
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Legal Business Name | ASTEGOS, INC
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 3550 W AMERICANA TER FL 1
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City | BOISE
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State | ID
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Zip | 83706-4728
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Country | US
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Telephone | 208-649-4099
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Fax |
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Provider Business Mailing Address
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Address Line | 13626 W BALDCYPRESS ST STE 119
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City | BOISE
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State | ID
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Zip | 83713-4803
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Country | US
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Telephone | 208-649-4099
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIM FLAHERTY
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Credential |
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Telephone | 208-954-2025
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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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