Provider Demographics
NPI:1982818290
Name:ALTA COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:ALTA COUNSELING ASSOCIATES
Other - Org Name:ALTA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-395-1713
Mailing Address - Street 1:5223 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2637
Mailing Address - Country:US
Mailing Address - Phone:208-395-1713
Mailing Address - Fax:208-395-1715
Practice Address - Street 1:5223 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2637
Practice Address - Country:US
Practice Address - Phone:208-395-1713
Practice Address - Fax:208-395-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTA ADDICTIONS AND MENTAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0027619Medicaid