MEDICARE: EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM1300X	Multi-Specialty Clinic/Center
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275932220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	2007 E QUAIL RUN RD
Second Line	:	STE 1
City	:	EMMETT
State	:	ID
Zip	:	83617-5059
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Provider Business Practice Location Address
First Line	:	2007 E QUAIL RUN RD
Second Line	:	STE 1
City	:	EMMETT
State	:	ID
Zip	:	83617-5059
Country	:	US
Telephone Number	:	208-365-5445
Fax Number	:	208-365-6226

Authorized Official
Title or Position	:	MEMBER/OFFICE MANAGER
Name	:	CATHY WALL
Credential	:
Telephone Number	:	208-365-5445

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	05/07/2026

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