Provider Demographics
NPI:1912238296
Name:GENESIS COUNSELING AND PSYCHOLOGICAL SERVICES INC
Entity type:Organization
Organization Name:GENESIS COUNSELING AND PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOLIOU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:208-375-7777
Mailing Address - Street 1:1327 S FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1306
Mailing Address - Country:US
Mailing Address - Phone:208-375-7777
Mailing Address - Fax:208-375-7598
Practice Address - Street 1:1323 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1306
Practice Address - Country:US
Practice Address - Phone:208-375-7777
Practice Address - Fax:208-375-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1680409Medicare PIN