Provider Demographics
NPI:1396865432
Name:LUTHERAN COMMUNITY SERVICES NW
Entity Type:Organization
Organization Name:LUTHERAN COMMUNITY SERVICES NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DONAHUE
Authorized Official - Suffix:
Authorized Official - Credentials:CSWP
Authorized Official - Phone:208-323-0996
Mailing Address - Street 1:410 S ORCHARD ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1260
Mailing Address - Country:US
Mailing Address - Phone:208-323-0996
Mailing Address - Fax:208-685-0587
Practice Address - Street 1:410 S ORCHARD ST
Practice Address - Street 2:SUITE 124
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1260
Practice Address - Country:US
Practice Address - Phone:208-323-0996
Practice Address - Fax:208-685-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty