Provider Demographics
NPI:1467064139
Name:COMPASSIONATE TRAUMA THERAPY, LLC
Entity Type:Organization
Organization Name:COMPASSIONATE TRAUMA THERAPY, LLC
Other - Org Name:TREASURE VALLEY COMPASSTIONATE THERAPY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:208-391-3141
Mailing Address - Street 1:1152 BOND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-3501
Mailing Address - Country:US
Mailing Address - Phone:208-391-3141
Mailing Address - Fax:
Practice Address - Street 1:1152 BOND AVE STE B
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-3501
Practice Address - Country:US
Practice Address - Phone:208-391-3141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-23
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health