Organization
BROADTREE INTEGRATIVE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE HATZENBUEHLER LCSW (LCSW/OWNER)
(208) 922-7064
Entity
Organization
Contact information
Practice address
409 N MAIN ST, HAILEY, ID 83333-8416
(208) 922-7064
(208) 928-7647
Mailing address
409 N MAIN ST, HAILEY, ID 83333-8416
(208) 922-7064
(208) 928-7647
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831362821
TYPE 1 NPI
ME
Enumeration date
09/11/2018
Last updated
09/11/2018
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