Provider Demographics
NPI:1770113243
Name:TREE CITY WELLNESS, LLC
Entity type:Organization
Organization Name:TREE CITY WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTEENA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LAMFT
Authorized Official - Phone:208-817-0234
Mailing Address - Street 1:410 S ORCHARD ST STE 128
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1288
Mailing Address - Country:US
Mailing Address - Phone:208-817-0234
Mailing Address - Fax:833-898-4093
Practice Address - Street 1:410 S ORCHARD ST STE 128
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1288
Practice Address - Country:US
Practice Address - Phone:208-817-0234
Practice Address - Fax:833-898-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty