| Revive Counseling, Llc | |
|
9601 W State St Ste 208 Boise ID 83714-4021 | |
| (208) 794-8955 | |
| Not Available |
| Full Name | Revive Counseling, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9601 W State St Ste 208, Boise, Idaho |
| Authorized Official Name and Position | Kapka Smith (OWNER) |
| Authorized Official Contact | 2087948955 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Counseling, Llc 9601 W State St Ste 208 Boise ID 83714-4021 Ph: (208) 794-8955 | Revive Counseling, Llc 9601 W State St Ste 208 Boise ID 83714-4021 Ph: (208) 794-8955 |
| NPI Number | 1952976615 |
|---|---|
| Provider Enumeration Date | 05/25/2021 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Medicare PECOS PAC ID | 9830573260 |
|---|---|
| Medicare Enrollment ID | O20220901003185 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952976615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Kapka Zlatkova Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447758990 PECOS PAC ID: 7911381348 Enrollment ID: I20220901003294 |
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