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General NPI Number Information
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NPI Number | 1689074338
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Entity Type | Organization
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Legal Business Name | QUEST COUNSELING LLC
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 08/31/2014
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Provider Practice Location Address
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Address Line | 17 12TH AVE S SUITE 201
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City | NAMPA
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State | ID
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Zip | 83651-3952
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Country | US
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Telephone | 208-615-3956
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 W HAVENWOOD AVE
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City | NAMPA
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State | ID
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Zip | 83651-5003
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Country | US
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Telephone | 208-369-0092
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHARLAYNE WALL
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Credential | LCPC
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Telephone | 208-615-3956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 175316
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License Number State | ID
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