Organization
BROADER WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY MARTINEZ LCPC (LLC MEMBER/MANAGER)
(986) 279-3252
Entity
Organization
Contact information
Practice address
3350 W AMERICANA TER STE 210A, BOISE, ID 83706-2521
(986) 279-3252
(208) 908-0034
Mailing address
PO BOX 6421, BOISE, ID 83707-6421
(986) 279-3252
(208) 908-0034
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
12/09/2024
Last updated
12/09/2024
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