Provider Demographics
NPI:1144362021
Name:COUNSELING ASSOCIATES PLLC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANCEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-938-4764
Mailing Address - Street 1:PO BOX 1685
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-9104
Mailing Address - Country:US
Mailing Address - Phone:208-938-4764
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:742 E STATE STREET
Practice Address - Street 2:SUITE 160
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-938-4764
Practice Address - Fax:208-323-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8F686OtherBLUE CROSS OF IDAHO
ID000010142980OtherREGENCE BLUE SHIELD OF ID
1378960Medicare ID - Type Unspecified