| Organization Name: | EAGLE HEALTH AND WELLNESS, INC |
| NPI Number: | 1083937049 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KATHERINE MICHELLE ELSTUN (PRESIDENT AND MEDICAL DIRECTOR) |
| Mailing Address: | 3771 N Eagle Rd Boise |
| State: | ID US |
| Postal Code: | 837135005 |
| Phone Number: | 2089384040 |
| Fax Number: | 2089384099 |
| NPI Enumeration Date: | 03/04/2010 |
| NPI Last Update Date: | 03/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | LCPC-2918 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |