Provider Demographics
NPI:1851661052
Name:CORE COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:CORE COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-570-8894
Mailing Address - Street 1:847 PARKCENTRE WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1792
Mailing Address - Country:US
Mailing Address - Phone:208-467-2673
Mailing Address - Fax:208-467-4150
Practice Address - Street 1:847 PARKCENTRE WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1792
Practice Address - Country:US
Practice Address - Phone:208-467-2673
Practice Address - Fax:208-467-4150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)