Provider Demographics
NPI:1265202675
Name:CATALYST COUNSELING AND WELLNESS LLC
Entity type:Organization
Organization Name:CATALYST COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVALON
Authorized Official - Middle Name:
Authorized Official - Last Name:DERLACKI PRENTISS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-207-8889
Mailing Address - Street 1:1015 W HAYS ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5412
Mailing Address - Country:US
Mailing Address - Phone:208-207-8889
Mailing Address - Fax:
Practice Address - Street 1:1015 W HAYS ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5412
Practice Address - Country:US
Practice Address - Phone:208-207-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health