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Organization

CANDLEWOOD FAMILY COUNSELING CENTER, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. ELLA DINGMAN LCSW (ADMINSTRATOR)
(208) 478-8340
Entity
Organization

Contact information

Practice address
335 N MAIN ST, POCATELLO, ID 83204-3108
(208) 478-8340
(208) 478-8341
Mailing address
335 N MAIN ST, POCATELLO, ID 83204-3108
(208) 478-8340
(208) 478-8341

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1093911828
ID
05
1588860308
ID
05
1831395656
ID
05
1912103748
ID
Enumeration date
01/11/2007
Last updated
01/16/2013
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