Organization
WIXOM COUNSELING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET WIXOM LCSW (OWNER)
(208) 643-2832
Entity
Organization
Contact information
Practice address
4344 E NIBLEY CIR, IDAHO FALLS, ID 83401-3783
(208) 521-4433
Mailing address
4344 E NIBLEY CIR, IDAHO FALLS, ID 83401-3783
(208) 521-4433
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-24803
ID
Other
Enumeration date
07/18/2017
Last updated
07/21/2022
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