Organization
ICARE CENTER FOR CHANGE
Active
Parent organization
ICARE TELECARE
Other names
iCareTeleCare
Organization subpart
Yes
Provider details
NPI number
Legal business name
ICARE TELECARE
Authorized official
KELLY GRAFF APRN-CNS (OWNER, CLINICIAN)
(208) 918-2473
Entity
Organization
Contact information
Practice address
1689 E 4000 N, BUHL, ID 83316-5647
(208) 918-2473
Mailing address
1689 E 4000 N, BUHL, ID 83316-5647
(208) 918-2473
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558567107
—
ID
Enumeration date
04/25/2023
Last updated
04/25/2023
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