=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578421129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREVITY TREATMENT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2026
-----------------------------------------------------
Last Update Date | 02/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 618 W COLLEGE AVE
-----------------------------------------------------
City | SAINT MARIES
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83861-5010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-680-9042
-----------------------------------------------------
Fax | 877-471-2556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 266
-----------------------------------------------------
City | FERNWOOD
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83830-0266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-680-9042
-----------------------------------------------------
Fax | 877-471-2556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SHAYNE MOSES AGUIRRE
-----------------------------------------------------
Credential | AADC, LPC
-----------------------------------------------------
Telephone | 208-568-1398
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------