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General NPI Number Information
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NPI Number | 1902692809
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Entity Type | Organization
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Legal Business Name | RIVERSIDE COUNSELING LLC
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1491 S TYRELL LN STE 102
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City | BOISE
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State | ID
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Zip | 83706-4032
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Country | US
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Telephone | 208-410-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 6853 N ROE AVE
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City | BOISE
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State | ID
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Zip | 83714-2191
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Country | US
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Telephone | 951-398-9720
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | DELANEY BREANNE OBALDIA
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Credential | M.A., LPC
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Telephone | 208-410-8564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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