Provider Demographics
NPI:1124728688
Name:AMETRINE COUNSELING AND WELLNESS, LLP
Entity type:Organization
Organization Name:AMETRINE COUNSELING AND WELLNESS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-477-8217
Mailing Address - Street 1:714 MAIN ST STE 206
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-3744
Mailing Address - Country:US
Mailing Address - Phone:208-477-8217
Mailing Address - Fax:208-601-6184
Practice Address - Street 1:714 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-3744
Practice Address - Country:US
Practice Address - Phone:208-477-8217
Practice Address - Fax:208-601-6184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty