Provider Demographics
NPI:1750096780
Name:BOUNDARY CREEK COUNSELING LLC
Entity type:Organization
Organization Name:BOUNDARY CREEK COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HEYREND
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-391-5345
Mailing Address - Street 1:8660 W EMERALD ST STE 112
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4829
Mailing Address - Country:US
Mailing Address - Phone:208-391-5345
Mailing Address - Fax:
Practice Address - Street 1:8660 W EMERALD ST STE 112
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-4829
Practice Address - Country:US
Practice Address - Phone:208-391-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty