Provider Demographics
NPI:1386768943
Name:POIGNANT POSSIBILITIES, LLC
Entity type:Organization
Organization Name:POIGNANT POSSIBILITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR -COOWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:KELLICUT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, LMFT
Authorized Official - Phone:208-667-8474
Mailing Address - Street 1:1420 LINCOLN WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2390
Mailing Address - Country:US
Mailing Address - Phone:208-667-8474
Mailing Address - Fax:208-665-5704
Practice Address - Street 1:1420 LINCOLN WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2390
Practice Address - Country:US
Practice Address - Phone:208-667-8474
Practice Address - Fax:208-665-5704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 137101Y00000X
WALH00003616101Y00000X
IDLCSW 1791041C0700X
WALW000049111041C0700X
IDLMFT 3069106H00000X
WALF00000961106H00000X
IDLMFT 3089106H00000X
WALF00001127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty