Organization
NORTH FORK COUNSELING SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON BURNHAM LCSW (OWNER/MANAGER)
(208) 201-1300
Entity
Organization
Contact information
Practice address
2691 S 2000 W, REXBURG, ID 83440-4049
(208) 701-9616
Mailing address
PO BOX 64, SUGAR CITY, ID 83448-0064
(208) 701-9616
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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