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General NPI Number Information
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NPI Number | 1881113413
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Entity Type | Organization
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Legal Business Name | BREVITY TREATMENT SERVICES
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 1809 E SHERMAN AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5873
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Country | US
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Telephone | 208-680-9042
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Fax | 877-471-2556
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Provider Business Mailing Address
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Address Line | 1809 E SHERMAN AVE
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City | COEUR D ALENE
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State | ID
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Zip | 83814-5873
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Country | US
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Telephone | 208-680-9042
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Fax | 877-471-2556
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | REBECCA BOSCH
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Credential | LCPC, MAC, QSUDP
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Telephone | 509-609-7550
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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 | MAC
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License Number State | ID
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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 | LCPC-3663
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC-3663
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License Number State | ID
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