=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750078168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLAS COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2023
-----------------------------------------------------
Last Update Date | 06/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1329 AMMON PARK DR
-----------------------------------------------------
City | AMMON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83406-4591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-557-9181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 AMMON PARK DR
-----------------------------------------------------
City | AMMON
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83406-4591
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-557-9181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALYSON M WEBSTER
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 208-516-1003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------