Organization
MOUNTAIN LAUREL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA LYNN OVERACRE (MENTAL HEALTH THERAPIST)
(910) 308-6764
Entity
Organization
Contact information
Practice address
133 MAIN AVE W, SUITE 300, TWIN FALLS, ID 83301
(910) 308-6764
Mailing address
1011 BELL LN, KIMBERLY, ID 83341-5182
(910) 308-6764
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/04/2024
Last updated
06/04/2024
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