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Take Heart Counseling Idaho PLLC

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Company Details

Name: Take Heart Counseling Idaho PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 16 Apr 2023 (2 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 5202864
Place of Formation: IDAHO
File Number: 874453
ZIP code: 83301
County: Twin Falls County
Principal Address: CAROLYN L JONES, LCSW 201 139 RIVER VISTA PLACE TWIN FALLS, ID 83301
Mailing Address: CAROLYN L JONES, LCSW 4523 KANAKA CT BUHL, ID 83316-5162

Agent

Name Role Address
Gary D Jones Agent 4523 KANAKA CT, BUHL, ID 83316

Member

Name Role Address Appointed On
Gary David Jones Member 4523 KANAKA CT, BUHL, ID 83316-5162 2024-03-03

Manager

Name Role Address Appointed On
Carolyn L Jones Manager 4523 KANAKA CT, BUHL, ID 83316-5162 2023-05-12

National Provider Identifier

NPI Number:
1700575024
Certification Date:
2023-06-17

Authorized Person:

Name:
CAROLYN LOUISE JONES
Role:
AUTHORIZED OFFICIAL
Phone:

Taxonomy:

Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No
Selected Taxonomy:
261QM0850X - Adult Mental Health Clinic/Center
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Annual Report 0005627570 2024-03-03
Amendment to Certificate 0005241142 2023-05-12
Initial Filing 0005202864 2023-04-16

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Date of last update: 02 Mar 2025

Sources: Idaho Secretary of State