| Rathdrum Counseling Center, Llc | |
|
14954 N Coeur Dalene St Rathdrum ID 83858-6484 | |
| (208) 687-0538 | |
| (208) 687-3185 |
| Full Name | Rathdrum Counseling Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 14954 N Coeur Dalene St, Rathdrum, Idaho |
| Authorized Official Name and Position | Lynn M Russell (OWNER/DIRECTOR) |
| Authorized Official Contact | 2086870538 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rathdrum Counseling Center, Llc 14954 N Coeur Dalene St Rathdrum ID 83858-6484 Ph: (208) 687-0538 | Rathdrum Counseling Center, Llc 14954 N Coeur Dalene St Rathdrum ID 83858-6484 Ph: (208) 687-0538 |
| NPI Number | 1083152144 |
|---|---|
| Provider Enumeration Date | 02/08/2017 |
| Last Update Date | 02/08/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083152144 | NPI | - | NPPES |
| 1437270097 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW 36280 (Idaho) | Primary |
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