Provider Demographics
NPI:1346090594
Name:WATER'S EDGE COUNSELING CENTER
Entity Type:Organization
Organization Name:WATER'S EDGE COUNSELING CENTER
Other - Org Name:WATER'S EDGE COUSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:BRYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-996-0325
Mailing Address - Street 1:2168 N GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5496
Mailing Address - Country:US
Mailing Address - Phone:951-970-6576
Mailing Address - Fax:
Practice Address - Street 1:3597 E MONARCH SKY LN
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:208-996-0325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)