1477605806 NPI number — MONARCH COUNSELING SERVICES

Table of content: (NPI 1477605806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477605806 NPI number — MONARCH COUNSELING SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONARCH COUNSELING SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477605806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1869 E SELTICE WAY # 389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POST FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83854-7082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-964-4879
Provider Business Mailing Address Fax Number:
208-765-2558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 NORTHWEST BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-2488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-964-4879
Provider Business Practice Location Address Fax Number:
208-765-2558
Provider Enumeration Date:
01/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MILES
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
MADREE
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
208-964-4879

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 807652000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807335700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807342300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".