Organization
CORBETT SOUSA
Active
Other names
Achieving Family Wellness LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATY SIMMONS (CREDENTIALING/BILLING)
(208) 452-6580
Entity
Organization
Contact information
Practice address
16 12TH AVE S STE 208, NAMPA, ID 83651-3937
(208) 649-6048
(208) 906-2343
Mailing address
16 12TH AVE S STE 208, NAMPA, ID 83651-3937
(208) 649-6048
(208) 906-2343
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
37239
ID
Other
Enumeration date
06/22/2018
Last updated
06/22/2018
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