Provider Demographics
NPI:1841302171
Name:HAUDER SERVICES LTD
Entity type:Organization
Organization Name:HAUDER SERVICES LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC LMFT
Authorized Official - Phone:208-336-0200
Mailing Address - Street 1:1674 HILL RD
Mailing Address - Street 2:STE 14
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0958
Mailing Address - Country:US
Mailing Address - Phone:208-336-0200
Mailing Address - Fax:208-336-3837
Practice Address - Street 1:1674 HILL RD
Practice Address - Street 2:STE 14
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0958
Practice Address - Country:US
Practice Address - Phone:208-336-0200
Practice Address - Fax:208-336-3837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC52101YP2500X
IDLMFT2844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010016724OtherBLUE SHIELD
IDQ4624OtherBLUE CROSS
IDQ4624OtherBLUE CROSS