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Organization
ICARE CENTER FOR CHANGE
Active
Organization
ICARE CENTER FOR CHANGE
Active
Parent organization
ICARE TELECARE
Other names
iCareTeleCare
Organization subpart
Yes
Provider details
NPI number
Legal business name
ICARE TELECARE
Authorized official
KELLY GRAFF APRN-CNS (OWNER, CLINICIAN)
(208) 918-2473
Entity
Organization
Contact information
Practice address
1689 E 4000 N, BUHL, ID 83316-5647
(208) 918-2473
Mailing address
1689 E 4000 N, BUHL, ID 83316-5647
(208) 918-2473
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558567107
—
ID
Enumeration date
04/25/2023
Last updated
04/25/2023
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