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Organization
COUNSELING & TREATMENT CENTER OF IDAHO, LLC
Active
Organization
COUNSELING & TREATMENT CENTER OF IDAHO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH FINCH (OFFICE MANAGER)
(801) 857-9136
Entity
Organization
Contact information
Practice address
859 S YELLOWSTONE HWY STE 302, REXBURG, ID 83440-5294
(208) 932-5363
(205) 273-8403
Mailing address
859 S YELLOWSTONE HWY STE 302, REXBURG, ID 83440-5294
(208) 932-5363
(205) 273-8403
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IDTPID012974
—
ID
Enumeration date
01/03/2020
Last updated
10/23/2020
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