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General NPI Number Information
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NPI Number | 1902673866
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Entity Type | Organization
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Legal Business Name | CONNECT WITH LOVE LLC
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Dates
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Enumeration Date | 12/11/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 520 FIRST AMERICAN CIR
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City | REXBURG
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State | ID
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Zip | 83440-5400
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Country | US
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Telephone | 208-716-3659
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Fax |
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Provider Business Mailing Address
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Address Line | 3751 REDWOOD CT
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City | REXBURG
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State | ID
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Zip | 83440-4771
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Country | US
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Telephone | 208-716-3659
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RYAN LAIRD
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Credential | MBA
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Telephone | 208-716-3659
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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 |
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