Provider Demographics
NPI:1265564397
Name:CANYON COUNSELING CENTER INC.
Entity type:Organization
Organization Name:CANYON COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:STROWD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LMFT, MED
Authorized Official - Phone:208-454-1576
Mailing Address - Street 1:510 ARTHUR ST STE D
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3777
Mailing Address - Country:US
Mailing Address - Phone:208-454-1576
Mailing Address - Fax:208-454-9863
Practice Address - Street 1:510 ARTHUR ST STE D
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3777
Practice Address - Country:US
Practice Address - Phone:208-454-1576
Practice Address - Fax:208-454-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-2759101YP2500X
IDLCPC-84101YP2500X
IDLMFT-2619106H00000X
IDLMFT-2627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty