Provider Demographics
NPI:1144235565
Name:LIFEMATTERS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIFEMATTERS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLES
Authorized Official - Suffix:
Authorized Official - Credentials:L C P C
Authorized Official - Phone:208-383-0072
Mailing Address - Street 1:4696 W OVERLAND RD
Mailing Address - Street 2:268
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4696 W OVERLAND RD
Practice Address - Street 2:268
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2845
Practice Address - Country:US
Practice Address - Phone:208-383-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty