Provider Demographics
NPI:1326386202
Name:HILLCREST COUNSELING AND TESTING CENTER - PLLC
Entity type:Organization
Organization Name:HILLCREST COUNSELING AND TESTING CENTER - PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-284-7208
Mailing Address - Street 1:4696 W. OVERLAND RD.
Mailing Address - Street 2:SUITE 156
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2878
Mailing Address - Country:US
Mailing Address - Phone:208-284-7208
Mailing Address - Fax:208-577-6617
Practice Address - Street 1:4696 W. OVERLAND RD.
Practice Address - Street 2:SUITE 156
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2878
Practice Address - Country:US
Practice Address - Phone:208-284-7208
Practice Address - Fax:208-577-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3441261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)