Provider Demographics
NPI:1437882123
Name:WILD HEART LIVING
Entity Type:Organization
Organization Name:WILD HEART LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:CHAPDELAINE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-515-7588
Mailing Address - Street 1:1005 E PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7722
Mailing Address - Country:US
Mailing Address - Phone:208-505-7300
Mailing Address - Fax:
Practice Address - Street 1:1005 E PARK BLVD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-7722
Practice Address - Country:US
Practice Address - Phone:208-505-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty