Banyan Tree Wellness, PLLC
Community/Behavioral Health in Boise, ID. Organization (NPI-2).
NPI number1164047460
StatusActive
Last updated in NPPESJun 5, 2024
Details
- NPI
- 1164047460
- Entity type
- Organization (NPI-2)
- Legal business name
- Banyan Tree Wellness, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 11, 2020
- Certification date
- Aug 24, 2023
- Last updated
- Jun 5, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
410 S Orchard St Ste 124Boise, ID 83705-1210
Phone 208-398-0826
Mailing address
410 S Orchard St Ste 124Boise, ID 83705-1210
Phone 208-398-0826
Authorized official
Billylynn Pestell
Therapist/Owner
2083980826
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