Provider Demographics
NPI:1629613823
Name:COUNSELING SOLUTIONS CENTER LLC
Entity Type:Organization
Organization Name:COUNSELING SOLUTIONS CENTER LLC
Other - Org Name:JESSICA BULLWINKLE, MA, LMFT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANGELIC
Authorized Official - Last Name:BULLWINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:208-231-7308
Mailing Address - Street 1:2618 E SNOCREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5816
Mailing Address - Country:US
Mailing Address - Phone:208-231-7308
Mailing Address - Fax:
Practice Address - Street 1:2618 EAST SNOCREEK
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616
Practice Address - Country:US
Practice Address - Phone:208-231-7308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty