Provider Demographics
NPI:1457112039
Name:PSYCH COLLECTIVE
Entity type:Organization
Organization Name:PSYCH COLLECTIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-244-0120
Mailing Address - Street 1:1110 W PARK PL STE 202
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2783
Mailing Address - Country:US
Mailing Address - Phone:208-244-0120
Mailing Address - Fax:
Practice Address - Street 1:1110 W PARK PL STE 202
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2783
Practice Address - Country:US
Practice Address - Phone:208-244-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-19
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty