Provider Demographics
NPI:1750859781
Name:TRAILHEAD COUNSELING AND GRIEF SERVICES LLC
Entity Type:Organization
Organization Name:TRAILHEAD COUNSELING AND GRIEF SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-409-8120
Mailing Address - Street 1:17917 N EVANTON WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5524
Mailing Address - Country:US
Mailing Address - Phone:208-409-8120
Mailing Address - Fax:
Practice Address - Street 1:17917 N EVANTON WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-5524
Practice Address - Country:US
Practice Address - Phone:208-409-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)