Organization
DYNOVION COGNITIVE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY J HOEKSTRA (CEO)
(208) 964-7189
Entity
Organization
Contact information
Practice address
12550 W EXPLORER DR, BOISE, ID 83713-1826
(986) 230-2245
Mailing address
14233 SILVER RIDGE RD, CALDWELL, ID 83607-5448
(208) 964-7189
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/23/2025
Last updated
05/23/2025
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