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Idaho Counseling and Trauma Center, LLC

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Company Details

Name: Idaho Counseling and Trauma Center, LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 22 Nov 2022 (3 years ago)
Financial Date End: 30 Nov 2025
Entity Number: 4998923
Place of Formation: IDAHO
File Number: 850978
ZIP code: 83846
County: Shoshone County
Principal Address: SUITE 201-C 1218 DIVISION STREET SANDPOINT, ID 83846
Mailing Address: PO BOX 80 CARMEN, ID 83462

Agent

Name Role Address
DAVILLIER LAW GROUP, LLC Agent 414 CHURCH STREET, SUITE 308, SANDPOINT, ID 83864

National Provider Identifier

NPI Number:
1316649106
Certification Date:
2023-03-17

Authorized Person:

Name:
TAMARA K BAKER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
171400000X - Health & Wellness Coach
Is Primary:
No
Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
No
Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005975630 2024-11-08
Annual Report 0005447635 2023-10-24
Initial Filing 0004998923 2022-11-22

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Date of last update: 26 Mar 2025

Sources: Idaho Secretary of State