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Organization
CANDLEWOOD FAMILY COUNSELING CENTER, INC.
Active
Organization
CANDLEWOOD FAMILY COUNSELING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ELLA DINGMAN LCSW, ACSW (PRESIDENT, ADMINISTRATOR)
(208) 478-8340
Entity
Organization
Contact information
Practice address
335 N MAIN ST, POCATELLO, ID 83204-3108
(208) 478-8340
(208) 478-8341
Mailing address
PO BOX 2306, POCATELLO, ID 83206-2306
(208) 478-8340
(208) 478-8341
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093911828
—
ID
01
—
1174673305
PRIVATE INSURANCE
ID
05
—
1588860308
—
ID
05
—
1831395656
—
ID
05
—
1912103748
—
ID
Enumeration date
06/27/2007
Last updated
02/19/2015
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