Organization
FAMILY CARE CENTER, INC
Active
Other names
A New Life Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN OAKLEY LCPC (EXECUTIVE DIRECTOR)
20852988332
Entity
Organization
Contact information
Practice address
1582 N HOLMES AVENUE, IDAHO FALLS, ID 83401-2032
(208) 524-8832
(208) 535-7595
Mailing address
1582 N HOLMES AVENUE, IDAHO FALLS, ID 83401-2032
(208) 529-8832
(208) 535-7595
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
ID
101YP2500X
Professional Counselor
Primary
—
ID
103T00000X
Psychologist
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006240
BLUE SHIELD OF IDAHO
ID
05
—
002648300
—
ID
01
—
8333-7
BLUE CROSS OF IDAHO
ID
Enumeration date
06/26/2006
Last updated
08/17/2018
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