Provider Demographics
NPI:1972862290
Name:INTRASPECT COUNSELING LLC
Entity Type:Organization
Organization Name:INTRASPECT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FEEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCSP
Authorized Official - Phone:208-762-4405
Mailing Address - Street 1:88 W COMMERCE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7994
Mailing Address - Country:US
Mailing Address - Phone:208-762-4405
Mailing Address - Fax:888-977-1389
Practice Address - Street 1:88 W COMMERCE DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-7994
Practice Address - Country:US
Practice Address - Phone:208-762-4405
Practice Address - Fax:888-977-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4041101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty