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General NPI Number Information
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NPI Number | 1528437878
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR CREATIVITY AND HEALING
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 410 S ORCHARD ST STE 188
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City | BOISE
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State | ID
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Zip | 83705-1260
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Country | US
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Telephone | 208-954-0734
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190675
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City | BOISE
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State | ID
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Zip | 83719-0675
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Country | US
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Telephone | 208-954-0734
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR, COUNSELOR
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Name | MS. RHYAN KIM GARCIA
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Credential | LPC, NCC
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Telephone | 208-954-0734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-4786
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License Number State | ID
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