| A Good Place Llc | |
|
4696 W. Overland Rd Suite 230 Boise ID 83705 | |
| (208) 739-3830 | |
| Not Available |
| Full Name | A Good Place Llc |
|---|---|
| Speciality | Counselor |
| Location | 4696 W. Overland Rd Suite 230, Boise, Idaho |
| Authorized Official Name and Position | Yvonne Iwasa (OWNER) |
| Authorized Official Contact | 2087393830 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Good Place Llc 1839 S Roosevelt St Boise ID 83705-2864 Ph: (208) 739-3830 | A Good Place Llc 4696 W. Overland Rd Suite 230 Boise ID 83705 Ph: (208) 739-3830 |
| NPI Number | 1497456917 |
|---|---|
| Provider Enumeration Date | 03/13/2023 |
| Last Update Date | 06/14/2024 |
| Certification Date | 06/14/2024 |
| Medicare PECOS PAC ID | 1052850690 |
|---|---|
| Medicare Enrollment ID | O20240828000479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497456917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Yvonne Renee Iwasa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1518630482 PECOS PAC ID: 2961941505 Enrollment ID: I20240828000642 |
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