| Mariana Counseling And Wellness, Llc | |
|
410 S Orchard St Ste 140 Boise ID 83705-1288 | |
| (503) 314-7435 | |
| Not Available |
| Full Name | Mariana Counseling And Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 410 S Orchard St Ste 140, Boise, Idaho |
| Authorized Official Name and Position | Staci Cooper (OWNER/PROVIDER) |
| Authorized Official Contact | 5033147435 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mariana Counseling And Wellness, Llc 410 S Orchard St Ste 140 Boise ID 83705-1288 Ph: (503) 314-7435 | Mariana Counseling And Wellness, Llc 410 S Orchard St Ste 140 Boise ID 83705-1288 Ph: (503) 314-7435 |
| NPI Number | 1396590345 |
|---|---|
| Provider Enumeration Date | 04/23/2024 |
| Last Update Date | 04/23/2024 |
| Certification Date | 04/23/2024 |
| Medicare PECOS PAC ID | 5799229209 |
|---|---|
| Medicare Enrollment ID | O20240625004210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396590345 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Staci Cooper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1629228663 PECOS PAC ID: 8224194212 Enrollment ID: I20240625004245 |
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