Provider Demographics
NPI:1881375483
Name:CONFLUENCE FUNCTIONAL AND INTEGRATIVE PSYCHIATRY LLC
Entity type:Organization
Organization Name:CONFLUENCE FUNCTIONAL AND INTEGRATIVE PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMONEY-HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:208-515-2812
Mailing Address - Street 1:1015 W HAYS ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5412
Mailing Address - Country:US
Mailing Address - Phone:208-515-2812
Mailing Address - Fax:888-551-6190
Practice Address - Street 1:1015 W HAYS ST STE 107
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5412
Practice Address - Country:US
Practice Address - Phone:208-293-4204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty