Provider Demographics
NPI:1912285891
Name:ARROWROCK COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:ARROWROCK COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MODRAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-319-9786
Mailing Address - Street 1:6568 S FEDERAL WAY
Mailing Address - Street 2:#124
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-9277
Mailing Address - Country:US
Mailing Address - Phone:208-319-9786
Mailing Address - Fax:
Practice Address - Street 1:204 S COLE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0934
Practice Address - Country:US
Practice Address - Phone:208-319-9786
Practice Address - Fax:208-319-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC4698101Y00000X, 101YM0800X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty