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Organization
FIRM FOUINDATIONS LLC
Active
Organization
FIRM FOUINDATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE PETERSON MS (CO-OWNER)
(208) 251-7885
Entity
Organization
Contact information
Practice address
2496 MESA ST, IDAHO FALLS, ID 83401-3369
(208) 251-7885
(208) 745-0527
Mailing address
2496 MESA ST, IDAHO FALLS, ID 83401-3369
(208) 251-7885
(208) 745-0527
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8068920
—
ID
Enumeration date
05/21/2007
Last updated
08/22/2020
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