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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
MRS. ELLA DINGMAN LCSW (ADMINSTRATOR)
(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
335 N MAIN ST, POCATELLO, ID 83204-3108
(208) 478-8340
(208) 478-8341
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093911828
—
ID
05
—
1588860308
—
ID
05
—
1831395656
—
ID
05
—
1912103748
—
ID
Enumeration date
01/11/2007
Last updated
01/16/2013
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