Organization
RBTD
Active
Other names
IMPACT
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE HAMPTON LSW (OWNER/LSW)
(208) 522-8899
Entity
Organization
Contact information
Practice address
152 E MAIN ST STE 106, RIGBY, ID 83442-5268
(208) 745-7831
(208) 745-0658
Mailing address
PO BOX 2106, IDAHO FALLS, ID 83403-2106
(208) 745-7831
(208) 745-0658
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807916400
—
ID
Enumeration date
05/23/2008
Last updated
05/27/2008
Update your record
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