Provider Demographics
NPI:1447852157
Name:AZURE RIVER WELLNESS, COUNSELING LLC
Entity type:Organization
Organization Name:AZURE RIVER WELLNESS, COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCLEAFT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-795-3377
Mailing Address - Street 1:6864 LAMPLIGHTER ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2443
Mailing Address - Country:US
Mailing Address - Phone:208-598-0372
Mailing Address - Fax:
Practice Address - Street 1:1524 W HAYS ST STE 202
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4035
Practice Address - Country:US
Practice Address - Phone:208-598-0372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health