Organization
INTERACTIVE SERVICE CONNECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETE MOLINO MED, LSW (PRESIDENT)
(208) 522-4026
Entity
Organization
Contact information
Practice address
2680 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 522-4026
(208) 522-4138
Mailing address
2680 CHANNING WAY, IDAHO FALLS, ID 83404-7517
(208) 522-4026
(208) 522-4138
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
ID
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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