Provider Demographics
NPI:1922467976
Name:FOOTHILLS COUNSELING & WELLNESS LLC
Entity Type:Organization
Organization Name:FOOTHILLS COUNSELING & WELLNESS LLC
Other - Org Name:NORTHEND MENTAL HEALTHCARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-429-3854
Mailing Address - Street 1:1819 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-429-3854
Mailing Address - Fax:208-336-7290
Practice Address - Street 1:1819 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-429-3854
Practice Address - Fax:208-336-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-35033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health