Provider Demographics
NPI:1689116246
Name:MAITRI HOUSE YOGA, LLC
Entity Type:Organization
Organization Name:MAITRI HOUSE YOGA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAPRIO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:503-962-9025
Mailing Address - Street 1:709 S PHILLIPPI ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1163
Mailing Address - Country:US
Mailing Address - Phone:503-962-9025
Mailing Address - Fax:208-433-4604
Practice Address - Street 1:1310 W HAYS ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5025
Practice Address - Country:US
Practice Address - Phone:503-962-9025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY 202991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty