Organization
WILD LIFE COMMUNITY COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEAN MICHAEL JENNINGS LCSW (LCSW)
(208) 416-3850
Entity
Organization
Contact information
Practice address
264 BLACK MOUNTAIN RD, BONNERS FERRY, ID 83805-5308
(208) 416-3850
Mailing address
PO BOX 172, BONNERS FERRY, ID 83805-0172
(208) 416-3850
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
05/26/2022
Last updated
01/11/2023
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