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General NPI Number Information
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NPI Number | 1679596068
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Entity Type | Organization
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Legal Business Name | POWDER BASIN ASSOCIATES INC
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 7905 N MEADOWLARK WAY STE C
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5041
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Country | US
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Telephone | 208-762-3979
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Fax | 208-762-4419
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Provider Business Mailing Address
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Address Line | 7905 N MEADOWLARK WAY STE C
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5041
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Country | US
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Telephone | 208-762-3979
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Fax | 208-762-4419
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Authorized Official
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Title or Position | OWNER
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Name | LYNN MOORE
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Credential |
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Telephone | 208-676-0472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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