Provider Demographics
NPI:1134966039
Name:PINES COUNSELING AND PLAY CENTER
Entity type:Organization
Organization Name:PINES COUNSELING AND PLAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-850-3542
Mailing Address - Street 1:12514 W MACUMBO ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5169
Mailing Address - Country:US
Mailing Address - Phone:208-850-3542
Mailing Address - Fax:
Practice Address - Street 1:12514 W MACUMBO ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5169
Practice Address - Country:US
Practice Address - Phone:208-850-3542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty