Provider Demographics
NPI:1083305544
Name:COEUR CONNECTIONS BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:COEUR CONNECTIONS BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-499-6311
Mailing Address - Street 1:1373 S BAKER LN
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-4609
Mailing Address - Country:US
Mailing Address - Phone:209-499-6311
Mailing Address - Fax:
Practice Address - Street 1:1373 S BAKER LN
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-4609
Practice Address - Country:US
Practice Address - Phone:209-499-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty