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Organization
SUZANNE GODFREY
Active
Organization
SUZANNE GODFREY
Active
Parent organization
CLUB, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLUB, INC.
Authorized official
MARDEE HARPER (EXECUTIVE DIRECTOR)
(208) 529-4673
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 529-4673
(208) 529-4676
Mailing address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 529-4673
(208) 529-4676
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-4355
ID
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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