| Banyan Tree Wellness, Pllc | |
|
410 S Orchard St Ste 124 Boise ID 83705-1210 | |
| (208) 398-0826 | |
| Not Available |
| Full Name | Banyan Tree Wellness, Pllc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 410 S Orchard St Ste 124, Boise, Idaho |
| Authorized Official Name and Position | Billylynn Pestell (THERAPIST/OWNER) |
| Authorized Official Contact | 2083980826 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Banyan Tree Wellness, Pllc 410 S Orchard St Ste 124 Boise ID 83705-1210 Ph: (208) 398-0826 | Banyan Tree Wellness, Pllc 410 S Orchard St Ste 124 Boise ID 83705-1210 Ph: (208) 398-0826 |
| NPI Number | 1164047460 |
|---|---|
| Provider Enumeration Date | 06/11/2020 |
| Last Update Date | 06/05/2024 |
| Certification Date | 08/24/2023 |
| Medicare PECOS PAC ID | 1557784691 |
|---|---|
| Medicare Enrollment ID | O20200708003188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164047460 | NPI | - | NPPES |
| 1497318802 | Other | MT | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Billylynn Leiuilani Pestell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497318802 PECOS PAC ID: 2466875505 Enrollment ID: I20200708003224 |
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