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General NPI Number Information
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NPI Number | 1972657526
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Entity Type | Organization
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Legal Business Name | GENESIS ASSOCIATES, INC.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 421 E COEUR DALENE AVE SUITE 2
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City | COEUR D ALENE
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State | ID
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Zip | 83814-1704
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Country | US
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Telephone | 208-664-1606
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Fax | 208-664-9685
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Provider Business Mailing Address
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Address Line | PO BOX 1677
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City | COEUR D ALENE
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State | ID
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Zip | 83816-1677
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Country | US
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Telephone | 208-664-1606
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Fax | 208-664-9685
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | MARK CORNELIUS
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Credential | M.S., M.A. LCPC
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Telephone | 208-664-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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