Provider Demographics
NPI:1255977914
Name:CENTER COUNSELING, LLC
Entity type:Organization
Organization Name:CENTER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:GOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-221-1161
Mailing Address - Street 1:265 E CHUBBUCK RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5055
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:208-237-9806
Practice Address - Street 1:140 EVANS LN
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1914
Practice Address - Country:US
Practice Address - Phone:208-237-3907
Practice Address - Fax:208-242-3786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER COUNSELING, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-18
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care