Organization
INNOVATIVE HEALTH CARE CONCEPTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA MICHELLE SMITH (PROGRAM DIRECTOR)
(208) 523-1130
Entity
Organization
Contact information
Practice address
111 E 16TH ST, IDAHO FALLS, IDAHO FALLS, ID 83404-5919
(208) 523-1130
(208) 529-6501
Mailing address
790 S HOLMES AVE, IDAHO FALLS, ID 83401-4749
(208) 529-8526
(208) 529-8597
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
2084P0800X
Psychiatry Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002741600
—
ID
Enumeration date
01/11/2007
Last updated
01/23/2023
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