Provider Demographics
NPI: | 1366122806 |
---|---|
Name: | SERENE INTEGRATIVE SERVICES, LLC |
Entity type: | Organization |
Organization Name: | SERENE INTEGRATIVE SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CATHERINE |
Authorized Official - Middle Name: | MICHELLE |
Authorized Official - Last Name: | STRIGOTTE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 208-215-5943 |
Mailing Address - Street 1: | 827 W PRAIRIE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | HAYDEN |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83835-8459 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-719-7158 |
Mailing Address - Fax: | 208-500-2508 |
Practice Address - Street 1: | 827 W PRAIRIE AVE |
Practice Address - Street 2: | |
Practice Address - City: | HAYDEN |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83835-8459 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-719-7158 |
Practice Address - Fax: | 208-500-2508 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-07-19 |
Last Update Date: | 2024-07-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent | Group - Multi-Specialty |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
No | 175T00000X | Other Service Providers | Peer Specialist | Group - Multi-Specialty | |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 364SP0810X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health, Child & Family | Group - Multi-Specialty |
No | 405300000X | Other Service Providers | Prevention Professional | Group - Multi-Specialty |