Provider Demographics
NPI:1598774861
Name:QUIET WATERS COUNSELING INC.
Entity Type:Organization
Organization Name:QUIET WATERS COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCONAUGHEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-378-1147
Mailing Address - Street 1:4235 NYSTROM WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2521
Mailing Address - Country:US
Mailing Address - Phone:208-378-1147
Mailing Address - Fax:
Practice Address - Street 1:4235 NYSTROM WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-2521
Practice Address - Country:US
Practice Address - Phone:208-378-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 295101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID=========OtherTAX I.D. NUMBER