Organization
LAKE CITY COUNSELING CENTER
Active
Parent organization
PEER SUPPORT
Other names
Peer Support
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEER SUPPORT
Authorized official
JENNIFER RIAN TUTTLE (OWNER)
(208) 819-2716
Entity
Organization
Contact information
Practice address
9705 N SHAW ST, HAYDEN, ID 83835-9716
(208) 625-9981
Mailing address
9705 N SHAW ST, HAYDEN, ID 83835-9716
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720513963
—
ID
Enumeration date
01/07/2020
Last updated
01/07/2020
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