MEDICARE: CHARACTER DEVELOPMENTAL 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1821944851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARACTER DEVELOPMENTAL COUNSELING LLC

Provider Business Mailing Address
First Line	:	784 S CLEARWATER LOOP STE R
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-9599
Country	:	US
Telephone Number	:	208-328-6097
Fax Number	:	208-856-1883

Provider Business Practice Location Address
First Line	:	3758 E AMITY AVE, SUITE 101
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687
Country	:	US
Telephone Number	:	208-328-6097
Fax Number	:	208-856-1883

Authorized Official
Title or Position	:	OWNER
Name	:	DAKOTA SIOUX GRENDE
Credential	:	LCSW
Telephone Number	:	208-328-6097

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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