| Empowered Through Play Llc | |
|
560 W Canfield Ave Ste 300 Coeur D Alene ID 83815-7950 | |
| (208) 758-7111 | |
| Not Available |
| Full Name | Empowered Through Play Llc |
|---|---|
| Speciality | Counselor |
| Location | 560 W Canfield Ave, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Stacia Carr Peterson (OWNER) |
| Authorized Official Contact | 2087587111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Empowered Through Play Llc 560 W Canfield Ave Ste 300 Coeur D Alene ID 83815-7950 Ph: (208) 758-7111 | Empowered Through Play Llc 560 W Canfield Ave Ste 300 Coeur D Alene ID 83815-7950 Ph: (208) 758-7111 |
| NPI Number | 1033588207 |
|---|---|
| Provider Enumeration Date | 09/17/2015 |
| Last Update Date | 08/16/2016 |
| Medicare PECOS PAC ID | 4082908579 |
|---|---|
| Medicare Enrollment ID | O20160805001167 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033588207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Idaho) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Barbara F Brinton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578642260 PECOS PAC ID: 9133222565 Enrollment ID: I20070305000780 |
| Provider Name | Joy'l L Jenkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679824965 PECOS PAC ID: 5991095887 Enrollment ID: I20160613001581 |
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