Organization
ABUNDANT WELLNES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMERA LEANN KINGHORN LCSW (THERAPIST)
(406) 560-8100
Entity
Organization
Contact information
Practice address
1125 E POLSTON AVE, SUITE A, POST FALLS, ID 83854-6045
(208) 457-1540
(208) 457-1202
Mailing address
1125 E POLSTON AVE, SUITE A, POST FALLS, ID 83854-6045
(208) 457-1540
(208) 457-1202
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LCSW28967
MT
Other
Enumeration date
06/17/2010
Last updated
06/17/2010
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