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General NPI Number Information
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NPI Number | 1689196610
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Entity Type | Organization
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Legal Business Name | K M HAYCRAFT LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 250 NORTHWEST BLVD STE 107A
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2971
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Country | US
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Telephone | 208-610-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 250 NORTHWEST BLVD STE 107A
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2971
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Country | US
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Telephone | 208-610-3561
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. CLINT PERKINS
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Credential |
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Telephone | 971-218-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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