| Redeeming Hearts Llc | |
|
1103 W Ironwood Dr Coeur D Alene ID 83814-2604 | |
| (509) 336-5972 | |
| Not Available |
| Full Name | Redeeming Hearts Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 1103 W Ironwood Dr, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Jack Anthony Venbrux (SOLE MEMBER) |
| Authorized Official Contact | 5093365972 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Redeeming Hearts Llc 1103 W Ironwood Dr Coeur D Alene ID 83814-2604 Ph: (509) 336-5972 | Redeeming Hearts Llc 1103 W Ironwood Dr Coeur D Alene ID 83814-2604 Ph: (509) 336-5972 |
| NPI Number | 1700379443 |
|---|---|
| Provider Enumeration Date | 06/07/2018 |
| Last Update Date | 10/25/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700379443 | NPI | - | NPPES |
| LCPC-6701 | Other | ID | PROVIDER LICENSE STATE OF IDAHO |
| LH60249089 | Other | WA | PROVIDER LICENSE WA STATE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LH60249089 (Washington) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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