Provider Demographics
NPI:1235774407
Name:WILDFLOWER INTUITIVE CENTER, LLC
Entity Type:Organization
Organization Name:WILDFLOWER INTUITIVE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW
Authorized Official - Phone:208-722-2200
Mailing Address - Street 1:4696 W OVERLAND RD STE 276
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2877
Mailing Address - Country:US
Mailing Address - Phone:208-722-2200
Mailing Address - Fax:208-912-0325
Practice Address - Street 1:4696 W OVERLAND RD STE 276
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2877
Practice Address - Country:US
Practice Address - Phone:208-722-2200
Practice Address - Fax:208-912-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty