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Organization
BANNOCK YOUTH FOUNDATION
Active
Organization
BANNOCK YOUTH FOUNDATION
Active
Parent organization
BANNOCK YOUTH FOUNDATION
Other names
M.K. Place
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNOCK YOUTH FOUNDATION
Authorized official
MS. CINDY K HANSEN M.A. (CLINICAL DIRECTOR)
(208) 234-4722
Entity
Organization
Contact information
Practice address
110 SOUTH 19TH, POCATELLO, ID 83201
(208) 234-4722
(208) 234-2135
Mailing address
P.O. BOX 246, POCATELLO, ID 83204
(208) 234-4722
(208) 234-2135
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
09/06/2013
Last updated
09/06/2013
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