Provider Demographics
NPI:1972657526
Name:GENESIS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:GENESIS ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MA LCPC
Authorized Official - Phone:208-664-1606
Mailing Address - Street 1:PO BOX 1677
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1677
Mailing Address - Country:US
Mailing Address - Phone:208-664-1606
Mailing Address - Fax:208-664-9685
Practice Address - Street 1:421 E COEUR DALENE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1704
Practice Address - Country:US
Practice Address - Phone:208-664-1606
Practice Address - Fax:208-664-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health