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Organization
BANNOCK COUNTY FAMILY TREATMENT CENTER
Active
Organization
BANNOCK COUNTY FAMILY TREATMENT CENTER
Active
Parent organization
BANNOCK COUNTY
Organization subpart
Yes
Provider details
NPI number
Legal business name
BANNOCK COUNTY
Authorized official
MRS. KIMBERLY JO ANDREW LCPC (CLINICAL DIRECTOR)
(208) 236-7089
Entity
Organization
Contact information
Practice address
141 N 6TH AVE, POCATELLO, ID 83201-6209
(208) 236-7089
(208) 236-7097
Mailing address
141 N 6TH AVE, POCATELLO, ID 83201-6209
(208) 236-7089
(208) 236-7097
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
05/26/2015
Last updated
05/26/2015
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