Organization
LAKE CITY COUNSELING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RIAN TUTTLE (OWNER)
(208) 819-2716
Entity
Organization
Contact information
Practice address
9705 N SHAW ST, HAYDEN, ID 83835-9716
(208) 625-9981
Mailing address
9705 N SHAW ST, HAYDEN, ID 83835-9716
(208) 819-2716
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID013454
—
ID
Enumeration date
04/25/2017
Last updated
07/06/2020
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