Organization
FULFILLMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA JEAN NIELSON LPC (MANAGER)
(208) 284-7233
Entity
Organization
Contact information
Practice address
14331 CREGO ST, CALDWELL, ID 83607-4815
(208) 284-7233
Mailing address
14331 CREGO ST, CALDWELL, ID 83607-4815
(208) 757-0067
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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