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General NPI Number Information
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NPI Number | 1790699916
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Entity Type | Organization
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Legal Business Name | MDR COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 913 S LATAH ST STE A
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City | BOISE
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State | ID
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Zip | 83705-2265
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Country | US
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Telephone | 208-402-8713
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Fax | 210-255-2135
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Provider Business Mailing Address
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Address Line | 11224 W CARTRIDGE ST
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City | BOISE
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State | ID
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Zip | 83713-3705
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Country | US
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Telephone | 503-423-7954
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Fax | 210-402-8713
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Authorized Official
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Title or Position | OWNER AND SOLE PROVIDER
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Name | MADELINE ROUSSEAU
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Credential |
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Telephone | 503-423-7954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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