Organization
PEACH COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARENE HEISLER LCSW (OWNER)
(208) 640-9257
Entity
Organization
Contact information
Practice address
2101 N LAKEWOOD DR, SUITE 234, COEUR D ALENE, ID 83814-2473
(208) 640-9257
Mailing address
2101 N LAKEWOOD DR, SUITE 234, COEUR D ALENE, ID 83814-2473
(208) 640-9257
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-29180
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1417079856
OWNER NPI#
ID
Enumeration date
02/10/2015
Last updated
11/28/2016
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