Organization
IDAHO STATE UNIVERSITY
Active
Parent organization
IDAHO STATE UNIVERSITY
Other names
ISU Pocatello Counseling Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO STATE UNIVERSITY
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
1400 E TERRY DR BLDG 63, POCATELLO, ID 83209-0001
(208) 240-1690
Mailing address
921 S 8TH AVE STOP 8120, POCATELLO, ID 83209-0002
(208) 240-1609
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/12/2020
Last updated
10/12/2020
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