Provider Demographics
NPI:1952065294
Name:PRACTICAL THERAPY LLC
Entity Type:Organization
Organization Name:PRACTICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-385-6305
Mailing Address - Street 1:9546 W MOSSYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5333
Mailing Address - Country:US
Mailing Address - Phone:505-385-6305
Mailing Address - Fax:
Practice Address - Street 1:1111 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1966
Practice Address - Country:US
Practice Address - Phone:208-900-3678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty