Organization
IDAHO TRAUMA THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HILLARY DAWN COOK LPC (OWNER)
(208) 391-2957
Entity
Organization
Contact information
Practice address
6126 W STATE ST STE 109, BOISE, ID 83703-2741
(208) 391-2957
Mailing address
6126 W STATE ST STE 109, BOISE, ID 83703-2741
(208) 391-2957
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
LPC-6772
ID
261QM0850X
Adult Mental Health Clinic/Center
LPC-6772
ID
261QM0855X
Adolescent and Children Mental Health Clinic/Center
LPC-6772
ID
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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