Provider Demographics
NPI:1891523247
Name:REBECCA DACUS COUNSELING LLC
Entity type:Organization
Organization Name:REBECCA DACUS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:DACUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-899-5766
Mailing Address - Street 1:2418 N VALMET AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3442
Mailing Address - Country:US
Mailing Address - Phone:208-899-5766
Mailing Address - Fax:
Practice Address - Street 1:13900 W WAINWRIGHT DR STE 101B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5028
Practice Address - Country:US
Practice Address - Phone:208-297-3365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty