Provider Demographics
NPI:1457112039
Name:THE CDA THERAPIST
Entity Type:Organization
Organization Name:THE CDA THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:BROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-244-0120
Mailing Address - Street 1:1110 W PARK PL STE 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2783
Mailing Address - Country:US
Mailing Address - Phone:208-244-0120
Mailing Address - Fax:
Practice Address - Street 1:1110 W PARK PL STE 202
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2783
Practice Address - Country:US
Practice Address - Phone:208-244-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CDA THERAPIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty