Organization
WHITE PINE COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH ANN KINMOUTH LCSW (OWNER)
(208) 667-8860
Entity
Organization
Contact information
Practice address
1104 W IRONWOOD DR, STE A, COEUR D ALENE, ID 83814-2605
(208) 667-8860
(208) 667-2119
Mailing address
1104 W IRONWOOD DR, STE A, COEUR D ALENE, ID 83814-2605
(208) 667-8860
(208) 667-2119
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW-796
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010139968
REGENCE BLUESHIELD
ID
01
—
L2045
BLUE CROSS OF IDAHO
ID
Enumeration date
02/01/2007
Last updated
08/22/2020
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