Provider Demographics
NPI:1083329585
Name:VILLAGE CREEK COUNSELING, PLLC
Entity Type:Organization
Organization Name:VILLAGE CREEK COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-522-7512
Mailing Address - Street 1:3597 E MONARCH SKY LN # F240
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1053
Mailing Address - Country:US
Mailing Address - Phone:208-522-7512
Mailing Address - Fax:208-401-3701
Practice Address - Street 1:3597 E MONARCH SKY LN # F240
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1053
Practice Address - Country:US
Practice Address - Phone:208-522-7512
Practice Address - Fax:208-401-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)