Provider Demographics
NPI:1417158338
Name:COMMUNITY OUTREACH COUNSELING LLC
Entity Type:Organization
Organization Name:COMMUNITY OUTREACH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-466-7443
Mailing Address - Street 1:2707 GARRITY BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3679
Mailing Address - Country:US
Mailing Address - Phone:208-466-7443
Mailing Address - Fax:208-466-5058
Practice Address - Street 1:2707 GARRITY BLVD STE 5
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3679
Practice Address - Country:US
Practice Address - Phone:208-466-7443
Practice Address - Fax:208-466-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID26327261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807120900Medicaid
ID807404500Medicaid
ID807197500Medicaid