MEDICARE: RESILIENCE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1568984961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENCE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3709 N LOCUST GROVE RD STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6450
Country	:	US
Telephone Number	:	208-871-3977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3709 N LOCUST GROVE RD STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-6450
Country	:	US
Telephone Number	:	208-871-3977
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATIE CONLON JACOBS
Credential	:	LCPC
Telephone Number	:	208-871-3977

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	07/21/2022

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