Provider Demographics
NPI:1376907485
Name:CLOVERLEAF THERAPY, LLC
Entity Type:Organization
Organization Name:CLOVERLEAF THERAPY, LLC
Other - Org Name:CLOVERLEAF THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIMLOSK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-523-5602
Mailing Address - Street 1:3000 PANCHERI DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-5095
Mailing Address - Country:US
Mailing Address - Phone:509-823-5629
Mailing Address - Fax:
Practice Address - Street 1:3000 PANCHERI DR UNIT 3
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-5095
Practice Address - Country:US
Practice Address - Phone:509-823-5629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 35130251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1538497615OtherNPI