| Creswell Counseling Center Llc | |
|
4172 N Creswell Way Boise ID 83713-2403 | |
| (208) 863-1404 | |
| (833) 340-7217 |
| Full Name | Creswell Counseling Center Llc |
|---|---|
| Speciality | Counselor |
| Location | 4172 N Creswell Way, Boise, Idaho |
| Authorized Official Name and Position | Rosemary Ladacy Luque (BUSINESS OWNER/PROVIDER) |
| Authorized Official Contact | 2088631404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Creswell Counseling Center Llc 4172 N Creswell Way Boise ID 83713-2403 Ph: (208) 863-1404 | Creswell Counseling Center Llc 4172 N Creswell Way Boise ID 83713-2403 Ph: (208) 863-1404 |
| NPI Number | 1962263897 |
|---|---|
| Provider Enumeration Date | 01/18/2024 |
| Last Update Date | 02/02/2024 |
| Certification Date | 02/02/2024 |
| Medicare PECOS PAC ID | 3971943754 |
|---|---|
| Medicare Enrollment ID | O20240426000812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962263897 | NPI | - | NPPES |
| 7365212 | Medicaid | ID | |
| 200000014376 | Other | ID | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rosemary Ladacy Luque |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1245225879 PECOS PAC ID: 4880034669 Enrollment ID: I20240426000907 |
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