| Practical Therapy Llc | |
|
1111 S Orchard St Boise ID 83705-1966 | |
| (208) 900-3678 | |
| Not Available |
| Full Name | Practical Therapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 1111 S Orchard St, Boise, Idaho |
| Authorized Official Name and Position | Travis Thoms (MANAGING MEMBER) |
| Authorized Official Contact | 5053856305 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Practical Therapy Llc 9546 W Mossywood Dr Boise ID 83709-5333 Ph: (505) 385-6305 | Practical Therapy Llc 1111 S Orchard St Boise ID 83705-1966 Ph: (208) 900-3678 |
| NPI Number | 1952065294 |
|---|---|
| Provider Enumeration Date | 10/22/2021 |
| Last Update Date | 10/22/2021 |
| Certification Date | 10/22/2021 |
| Medicare PECOS PAC ID | 9537506241 |
|---|---|
| Medicare Enrollment ID | O20240318000913 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952065294 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Travis Thoms |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1558751537 PECOS PAC ID: 6002253713 Enrollment ID: I20240318000889 |
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