Organization
RESTORATION WELLNESS OF IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MELANIE ELISH LONG-AZARY (OWNER)
(208) 794-4737
Entity
Organization
Contact information
Practice address
3164 E EASTGATE DR, BOISE, ID 83716-5637
(208) 794-4737
Mailing address
PO BOX 171362, BOISE, ID 83717-1362
(208) 794-4737
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP1600X
Pastoral Counselor
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
171R00000X
Interpreter
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/17/2024
Last updated
08/17/2024
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