Provider Demographics
NPI:1356117766
Name:BARBARA PERUSSE, LLC
Entity type:Organization
Organization Name:BARBARA PERUSSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-290-2457
Mailing Address - Street 1:504 N FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1925
Mailing Address - Country:US
Mailing Address - Phone:208-290-2457
Mailing Address - Fax:
Practice Address - Street 1:1009 HIGHWAY 2 STE D
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2713
Practice Address - Country:US
Practice Address - Phone:208-290-2457
Practice Address - Fax:208-683-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)