Organization
RATHDRUM COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN M RUSSELL LCSW (OWNER/DIRECTOR)
(208) 687-0538
Entity
Organization
Contact information
Practice address
14954 N COEUR DALENE ST, RATHDRUM, ID 83858-6484
(208) 687-0538
(208) 687-3185
Mailing address
14954 N COEUR DALENE ST, RATHDRUM, ID 83858-6484
(208) 687-0538
(208) 687-3185
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW 36280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437270097
—
ID
Enumeration date
02/08/2017
Last updated
02/08/2017
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