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General NPI Number Information
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NPI Number | 1912285891
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Entity Type | Organization
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Legal Business Name | ARROWROCK COUNSELING AND CONSULTING
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 04/16/2023
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Provider Practice Location Address
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Address Line | 204 S COLE RD
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City | BOISE
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State | ID
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Zip | 83709-0934
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Country | US
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Telephone | 208-319-9786
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Fax | 208-319-7773
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Provider Business Mailing Address
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Address Line | 6568 S FEDERAL WAY #124
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City | BOISE
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State | ID
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Zip | 83716-9277
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Country | US
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Telephone | 208-319-9786
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MR. BEVIN MODRAK
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Credential | LCPC
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Telephone | 208-319-9786
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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 | LCPC4698
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC4698
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License Number State | ID
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