Provider Demographics
NPI:1003301680
Name:SERENITY TREATMENT LLC
Entity Type:Organization
Organization Name:SERENITY TREATMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:FITTING
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-743-5906
Mailing Address - Street 1:1229 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-6901
Mailing Address - Country:US
Mailing Address - Phone:208-743-5906
Mailing Address - Fax:833-264-6643
Practice Address - Street 1:1229 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-6901
Practice Address - Country:US
Practice Address - Phone:208-743-5906
Practice Address - Fax:833-264-6643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-262731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1720414634OtherLCSW