Provider Demographics
NPI:1184362071
Name:RED OAK COUNSELING, LLC
Entity type:Organization
Organization Name:RED OAK COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-953-7721
Mailing Address - Street 1:5130 N ICE SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2040
Mailing Address - Country:US
Mailing Address - Phone:208-953-7721
Mailing Address - Fax:208-963-3106
Practice Address - Street 1:1406 N MAIN ST STE 114
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1798
Practice Address - Country:US
Practice Address - Phone:208-953-7721
Practice Address - Fax:208-963-3106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-22
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1396203212Medicaid