Provider Demographics
NPI:1528525193
Name:UNTANGLED COUNSELING, PLLC
Entity type:Organization
Organization Name:UNTANGLED COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-705-5424
Mailing Address - Street 1:94 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2052
Mailing Address - Country:US
Mailing Address - Phone:208-352-6640
Mailing Address - Fax:208-417-0975
Practice Address - Street 1:94 N PINE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2052
Practice Address - Country:US
Practice Address - Phone:208-352-6640
Practice Address - Fax:208-417-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)