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Organization
LIGHTHOUSE FOR RECOVERY, LLC
Active
Organization
LIGHTHOUSE FOR RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM C. SLAVEN LCSW, CADC (EXECUTIVE DIRECTOR)
(208) 237-3365
Entity
Organization
Contact information
Practice address
1135 YELLOWSTONE AVE, SUITE D, POCATELLO, ID 83201-5082
(208) 232-2908
(208) 232-5423
Mailing address
147 W LINDEN AVE, CHUBBUCK, ID 83202-2306
(208) 237-3365
(208) 232-5423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCSW 28016
ID
Other
Enumeration date
09/05/2011
Last updated
09/05/2011
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