Provider Demographics
NPI:1508405945
Name:NATE BONOVITZ COUNSELING, LLC
Entity Type:Organization
Organization Name:NATE BONOVITZ COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:
Authorized Official - Last Name:BONOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-557-5672
Mailing Address - Street 1:5218 N DECATUR DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2227
Mailing Address - Country:US
Mailing Address - Phone:484-557-5672
Mailing Address - Fax:
Practice Address - Street 1:1151 E IRON EAGLE DR
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6854
Practice Address - Country:US
Practice Address - Phone:484-557-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health