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General NPI Number Information
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NPI Number | 1558903328
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Entity Type | Organization
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Legal Business Name | DARING IN IDAHO, LLC
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Dates
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Enumeration Date | 10/14/2019
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 413 N ALLUMBAUGH STREET SUITE 102
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-515-7552
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Fax | 208-343-4458
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Provider Business Mailing Address
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Address Line | 413 N ALLUMBAUGH STREET SUITE 102
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City | BOISE
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State | ID
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Zip | 83704
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Country | US
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Telephone | 208-515-7552
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Fax | 208-343-4458
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Authorized Official
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Title or Position | OWNER
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Name | DIANA HAKES
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Credential | LCWS
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Telephone | 208-515-7552
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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 |
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License Number State |
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