Provider Demographics
NPI:1154483717
Name:LIFESPAN COUNSELING SERVICES
Entity Type:Organization
Organization Name:LIFESPAN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAUCLAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-344-0844
Mailing Address - Street 1:1510 ROBERT ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2528
Mailing Address - Country:US
Mailing Address - Phone:208-344-0844
Mailing Address - Fax:208-344-0592
Practice Address - Street 1:1510 ROBERT ST
Practice Address - Street 2:STE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2528
Practice Address - Country:US
Practice Address - Phone:208-344-0844
Practice Address - Fax:208-344-0592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty