Provider Demographics
NPI:1013494301
Name:LABYRINTH ASSESSMENT & BEHAVIORAL SERVICES PLLC
Entity Type:Organization
Organization Name:LABYRINTH ASSESSMENT & BEHAVIORAL SERVICES PLLC
Other - Org Name:LABYRINTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-317-0268
Mailing Address - Street 1:20 N MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MALAD CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83252-1281
Mailing Address - Country:US
Mailing Address - Phone:208-766-7623
Mailing Address - Fax:183-382-1301
Practice Address - Street 1:20 N MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:MALAD CITY
Practice Address - State:ID
Practice Address - Zip Code:83252-1281
Practice Address - Country:US
Practice Address - Phone:208-233-9136
Practice Address - Fax:208-233-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YP2500X
IDLCPC3275251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCPC-3275OtherMENTAL HEALTH