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General NPI Number Information
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NPI Number | 1528714144
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Entity Type | Organization
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Legal Business Name | IDAHO COUNSELING AND NEUROFEEDBACK
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 3348 E GOLDSTONE DR
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-571-2210
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 S EAGLE RD STE 110
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City | MERIDIAN
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State | ID
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Zip | 83642-6745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOGAN KATSEANES
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Credential | MS, LCPC, NCC
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Telephone | 208-866-4688
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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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