Provider Demographics
NPI:1720894231
Name:BARK AND MOSS COUNSELING GROUP PLLC
Entity type:Organization
Organization Name:BARK AND MOSS COUNSELING GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:LAMKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:208-559-6011
Mailing Address - Street 1:13601 W MCMILLAN RD # 102-104
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2025
Mailing Address - Country:US
Mailing Address - Phone:208-559-6011
Mailing Address - Fax:986-236-4264
Practice Address - Street 1:6126 W STATE ST STE 202
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2741
Practice Address - Country:US
Practice Address - Phone:208-559-6011
Practice Address - Fax:986-236-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty