Provider Demographics
NPI:1215316989
Name:CHARLY READ COUNSELING PLLC
Entity type:Organization
Organization Name:CHARLY READ COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-921-3197
Mailing Address - Street 1:1908 ALDER ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-5905
Mailing Address - Country:US
Mailing Address - Phone:208-921-3197
Mailing Address - Fax:208-658-4827
Practice Address - Street 1:123 E 44TH ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-5009
Practice Address - Country:US
Practice Address - Phone:208-921-3197
Practice Address - Fax:208-658-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-34740251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health