Provider Demographics
NPI:1972805224
Name:EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:EMMETT COUNSELING AND PSYCHIATRIC SERVICES, LLC
Other - Org Name:PAYETTE COUNSELING AND PSYCHIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-365-5445
Mailing Address - Street 1:501 N 16TH ST
Mailing Address - Street 2:110
Mailing Address - City:PAYETTE
Mailing Address - State:ID
Mailing Address - Zip Code:83661-2781
Mailing Address - Country:US
Mailing Address - Phone:208-642-2600
Mailing Address - Fax:208-642-6164
Practice Address - Street 1:501 N 16TH ST
Practice Address - Street 2:110
Practice Address - City:PAYETTE
Practice Address - State:ID
Practice Address - Zip Code:83661-2781
Practice Address - Country:US
Practice Address - Phone:208-642-2600
Practice Address - Fax:208-642-6164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health