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STATE OF MIND COUNSELING AND WELLNESS CENTER

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Company Details

Name: STATE OF MIND COUNSELING AND WELLNESS CENTER
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 18 Oct 2011 (14 years ago)
Entity Number: 458764
Place of Formation: IDAHO
File Number: 0000458764
ZIP code: 83616
County: Ada County
Mailing Address: 372 S EAGLE RD #326 EAGLE, ID 83616

National Provider Identifier

NPI Number:
1013277128

Authorized Person:

Name:
LYNDA SMITH
Role:
LPC
Phone:

Taxonomy:

Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
No
Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0855X - Adolescent and Children Mental Health Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0000458764 2011-10-18

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State