Provider Demographics
NPI:1952947822
Name:INTROSPECTIVE COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:INTROSPECTIVE COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HELSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-252-5009
Mailing Address - Street 1:10400 W OVERLAND RD # 278
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1433
Mailing Address - Country:US
Mailing Address - Phone:208-252-5009
Mailing Address - Fax:
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:208-252-5009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTROSPECTIVE COUNSELING & CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-25
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty