| Organization Name: | SEQUEL ALLIANCE FAMILY SERVICES, LLC |
| NPI Number: | 1154744357 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY CAUDLE (CBO DIRECTOR OF PATIENT ACCOUNTS) |
| Mailing Address: | 212 Rodeo Dr Moscow |
| State: | ID US |
| Postal Code: | 838439798 |
| Phone Number: | 2088825960 |
| Fax Number: | 2088820857 |
| NPI Enumeration Date: | 01/24/2014 |
| NPI Last Update Date: | 01/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | W132383 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |