Organization
ASHTON MEMORIAL, INC.
Active
Other names
The Counseling Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE BRADY (HR DIRECTOR)
(205) 652-7461
Entity
Organization
Contact information
Practice address
1301 E 17TH ST STE 4, IDAHO FALLS, ID 83404-6273
(208) 523-0787
(208) 523-3175
Mailing address
1301 E 17TH ST STE 4, IDAHO FALLS, ID 83404-6273
(208) 523-0787
(208) 523-3175
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003907163
—
ID
Enumeration date
06/28/2013
Last updated
06/28/2013
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