Basic Information
| Provider Information | |||||||||
| NPI: | 1073114625 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSIGHT FOR WELLNESS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 W. SUNSET AVE | ||||||||
| Address2: | STE 15 | ||||||||
| City: | COEUR D'ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838158366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660357 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Practice Location | |||||||||
| Address1: | 296 W. SUNSET AVE | ||||||||
| Address2: | STE 15 | ||||||||
| City: | COEUR D'ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838158366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660357 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2020 | ||||||||
| LastUpdateDate: | 11/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | KINCAID | ||||||||
| AuthorizedOfficialFirstName: | DONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSED PROFESSIONAL COUNSELOR/OWN | ||||||||
| AuthorizedOfficialTelephone: | 2086660357 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCPC | ||||||||
| NPICertificationDate: | 11/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.