Provider Demographics
NPI:1497888713
Name:HEALTHY PLACE COUNSELING, INC.
Entity Type:Organization
Organization Name:HEALTHY PLACE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:R
Authorized Official - Last Name:KORENKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-200-4818
Mailing Address - Street 1:255 B ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3566
Mailing Address - Country:US
Mailing Address - Phone:208-524-4818
Mailing Address - Fax:
Practice Address - Street 1:255 B ST
Practice Address - Street 2:SUITE 300
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3566
Practice Address - Country:US
Practice Address - Phone:208-524-4818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806909300Medicaid