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General NPI Number Information
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NPI Number | 1902716038
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Entity Type | Organization
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Legal Business Name | PINE COUNSELING, LCSW, PLLC
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Dates
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Enumeration Date | 09/10/2026
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Last Update Date | 09/10/2026
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Provider Practice Location Address
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Address Line | 930 N 6TH E
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City | MOUNTAIN HOME
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State | ID
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Zip | 83647-2208
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Country | US
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Telephone | 208-407-4728
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Fax |
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Provider Business Mailing Address
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Address Line | 999 W MAIN ST STE 100
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City | BOISE
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State | ID
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Zip | 83702-9001
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Country | US
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Telephone | 406-303-1882
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | COLTEN YOUNG SICARD
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Credential | LCSW
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Telephone | 208-407-4728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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