Organization
RATHDRUM COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN MARIE RUSSELL LMSW (EXECUTIVE DIRECTOR)
(208) 687-0538
Entity
Organization
Contact information
Practice address
15636 N HIGHWAY 41, RATHDRUM, ID 83858-8710
(208) 687-0538
(208) 687-3185
Mailing address
15636 N HIGHWAY 41, RATHDRUM, ID 83858-8710
(208) 687-0538
(208) 687-3185
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8076548
—
ID
Enumeration date
04/02/2007
Last updated
08/22/2020
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