Organization
FAMILY HEALTH SERVICES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY BLACKWOOD (CREDENTIALING SPECIALIST)
(208) 737-6718
Entity
Organization
Contact information
Practice address
621 N MAIN ST, BELLEVUE, ID 83313-5093
(208) 737-6718
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 737-6718
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
122300000X
Dentist
—
—
124Q00000X
Dental Hygienist
—
—
133V00000X
Registered Dietitian
—
—
183500000X
Pharmacist
—
—
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/13/2021
Last updated
05/26/2021
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