Provider Demographics
NPI:1770337818
Name:SERENITY THERAPEUTIC CONSULTATION LLC
Entity type:Organization
Organization Name:SERENITY THERAPEUTIC CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HEDELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-570-7234
Mailing Address - Street 1:17 12TH AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3952
Mailing Address - Country:US
Mailing Address - Phone:208-960-6916
Mailing Address - Fax:208-965-2052
Practice Address - Street 1:17 12TH AVE S STE 201
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3952
Practice Address - Country:US
Practice Address - Phone:208-960-6916
Practice Address - Fax:208-965-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty