| Wild Heart Living | |
|
1005 E Park Blvd Boise ID 83712-7722 | |
| (208) 505-7300 | |
| Not Available |
| Full Name | Wild Heart Living |
|---|---|
| Speciality | Counselor |
| Location | 1005 E Park Blvd, Boise, Idaho |
| Authorized Official Name and Position | Sheila Diane Chapdelaine (CLINICAL PSYCHOTHERAPIST) |
| Authorized Official Contact | 2085157588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Heart Living 1005 E Park Blvd Boise ID 83712-7722 Ph: (208) 505-7300 | Wild Heart Living 1005 E Park Blvd Boise ID 83712-7722 Ph: (208) 505-7300 |
| NPI Number | 1437882123 |
|---|---|
| Provider Enumeration Date | 07/08/2022 |
| Last Update Date | 07/08/2022 |
| Certification Date | 07/08/2022 |
| Medicare PECOS PAC ID | 7012399736 |
|---|---|
| Medicare Enrollment ID | O20220727003561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437882123 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Sheila D Chapdelaine |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780039545 PECOS PAC ID: 4587905278 Enrollment ID: I20190405001863 |
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