Provider Demographics
NPI:1952988461
Name:FLOURISH COUNSELING
Entity Type:Organization
Organization Name:FLOURISH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:PETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-755-1641
Mailing Address - Street 1:13403 N GOVERNMENT WAY STE 319
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-8905
Mailing Address - Country:US
Mailing Address - Phone:208-755-1641
Mailing Address - Fax:208-625-2054
Practice Address - Street 1:13403 N GOVERNMENT WAY STE 319
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8905
Practice Address - Country:US
Practice Address - Phone:208-755-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0000000000OtherN/A