Organization
ASHTON MEMORIAL, INC.
Active
Other names
Youth and Family Renewal Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA KELLOGG (ADMINISTRATOR)
(208) 652-7461
Entity
Organization
Contact information
Practice address
2935 ROLLANDET ST, IDAHO FALLS, ID 83402-4654
(208) 542-2905
(208) 522-2427
Mailing address
PO BOX 838, 700 N. 2ND STREET, ASHTON, ID 83420-0838
(208) 652-7461
(208) 652-7595
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805100400
—
ID
05
—
807195500
—
ID
05
—
807361800
—
ID
05
—
807641700
—
ID
Enumeration date
09/27/2006
Last updated
08/22/2020
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