Provider Demographics
NPI:1962707166
Name:RAISE THE BOTTOM TRAINING & COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:RAISE THE BOTTOM TRAINING & COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-433-0400
Mailing Address - Street 1:9196 W BARNES DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1552
Mailing Address - Country:US
Mailing Address - Phone:208-433-0400
Mailing Address - Fax:208-433-5271
Practice Address - Street 1:9196 W BARNES DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1552
Practice Address - Country:US
Practice Address - Phone:208-433-0400
Practice Address - Fax:208-433-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW29959101YA0400X
IDCS5613101YA0400X, 183500000X
IDMSW07060101YA0400X
IDN21523163W00000X
IDN40356163WA0400X
IDM6153207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID2387NTCOtherNARCOTIC TREATMENT CENTER
IDID-10008-MOtherOPIOID TREATMENT PROGRAM CERTIFICATION