Organization
BRICK HOUSE RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON D COOMBS MPC (CEO)
(801) 350-1716
Entity
Organization
Contact information
Practice address
3663 N LAKEHARBOR LN, BOISE, ID 83703
(801) 350-1716
(208) 286-4292
Mailing address
3663 N LAKEHARBOR LN, BOISE, ID 83703-6913
(801) 350-1716
(208) 286-4292
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
ID
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
ID
101YM0800X
Mental Health Counselor
—
ID
251S00000X
Community/Behavioral Health Agency
—
ID
Other
Enumeration date
10/17/2014
Last updated
12/30/2019
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