Organization
LAKE CITY COUNSELING CENTER
Active
Other names
CBRS
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
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720513963
—
ID
Enumeration date
01/07/2020
Last updated
01/07/2020
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