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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

Member

Name Role Address Appointed On
Tamara Baker Member PO BOX 80, CARMEN, ID 83462 2023-10-24

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: 10 Jul 2025

Sources: Idaho Secretary of State