| Rathdrum Counseling Center Llc | |
|
15636 N Highway 41 Rathdrum ID 83858-8710 | |
| (208) 687-0538 | |
| (208) 687-3185 |
| Full Name | Rathdrum Counseling Center Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 15636 N Highway 41, Rathdrum, Idaho |
| Authorized Official Name and Position | Lynn Marie Russell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2086870538 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rathdrum Counseling Center Llc 15636 N Highway 41 Rathdrum ID 83858-8710 Ph: (208) 687-0538 | Rathdrum Counseling Center Llc 15636 N Highway 41 Rathdrum ID 83858-8710 Ph: (208) 687-0538 |
| NPI Number | 1437270097 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4880902303 |
|---|---|
| Medicare Enrollment ID | O20160511002827 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437270097 | NPI | - | NPPES |
| 8076548 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Sharene Heisler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417079856 PECOS PAC ID: 0446326953 Enrollment ID: I20080908000291 |
| Provider Name | David L Alverson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265979199 PECOS PAC ID: 0244513380 Enrollment ID: I20170215000800 |
Rathdrum Counseling Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14954 N Coeur Dalene St, Rathdrum, ID 83858 Phone: 208-687-0538 Fax: 208-687-3185 | |
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