Provider Demographics
NPI:1205603669
Name:HEART AT PEACE COUNSELING PLLC
Entity type:Organization
Organization Name:HEART AT PEACE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-590-5739
Mailing Address - Street 1:2596 N STOKESBERRY PL STE 180
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6282
Mailing Address - Country:US
Mailing Address - Phone:208-590-5739
Mailing Address - Fax:
Practice Address - Street 1:2596 N STOKESBERRY PL STE 180
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6282
Practice Address - Country:US
Practice Address - Phone:208-590-5739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972043966OtherNPPES