Provider Demographics
NPI:1134320104
Name:WHITE PINE COUNSELING
Entity type:Organization
Organization Name:WHITE PINE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:208-667-8860
Mailing Address - Street 1:1104 W IRONWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2605
Mailing Address - Country:US
Mailing Address - Phone:208-667-8860
Mailing Address - Fax:208-667-2119
Practice Address - Street 1:1104 W IRONWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2605
Practice Address - Country:US
Practice Address - Phone:208-667-8860
Practice Address - Fax:208-667-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-134251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1690906Medicare ID - Type Unspecified