Organization
HEALTHY PLACE COUNSELING POCATELLO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRK KORENKE (OWNER)
(208) 200-4818
Entity
Organization
Contact information
Practice address
1023 YELLOWSTONE AVE, STE. J, POCATELLO, ID 83201-4478
(208) 233-1276
(208) 233-0835
Mailing address
1023 YELLOWSTONE AVE, STE. J, POCATELLO, ID 83201-4478
(208) 233-1276
(208) 233-0835
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807364700
—
ID
Enumeration date
02/15/2007
Last updated
02/26/2016
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