Organization
LIGHTHOUSE FOR RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM C. SLAVEN LCSW, CADC (EXECUTIVE DIRECTOR)
(208) 237-3365
Entity
Organization
Contact information
Practice address
1135 YELLOWSTONE AVE, SUITE D, POCATELLO, ID 83201-5082
(208) 232-2908
(208) 232-5423
Mailing address
147 W LINDEN AVE, CHUBBUCK, ID 83202-2306
(208) 237-3365
(208) 232-5423
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCSW 28016
ID
Other
Enumeration date
09/05/2011
Last updated
09/05/2011
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