MEDICARE: BREVITY TREATMENT SERVICES 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1578421129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREVITY TREATMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 266
Second Line	:
City	:	FERNWOOD
State	:	ID
Zip	:	83830-0266
Country	:	US
Telephone Number	:	208-680-9042
Fax Number	:	877-471-2556

Provider Business Practice Location Address
First Line	:	618 W COLLEGE AVE
Second Line	:
City	:	SAINT MARIES
State	:	ID
Zip	:	83861-5010
Country	:	US
Telephone Number	:	208-680-9042
Fax Number	:	877-471-2556

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SHAYNE MOSES AGUIRRE
Credential	:	AADC, LPC
Telephone Number	:	208-568-1398

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	02/05/2026

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