Organization
INTENTIONAL SUPPORT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE J GULLICKSON (REGISTERED AGENT)
(208) 371-0641
Entity
Organization
Contact information
Practice address
5840 S MANDOLIN PL, BOISE, ID 83709-6377
(208) 371-0641
Mailing address
5840 S MANDOLIN PL, BOISE, ID 83709-6377
(208) 371-0641
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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