Organization
TW MCKNIGHT ENTERPRISES
Active
Other names
LIFESPAN FAMILY PRACTICE MENTAL HEALTH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY L MCKNIGHT (OWNER)
(208) 736-7090
Entity
Organization
Contact information
Practice address
550 POLK ST, SUITE A, TWIN FALLS, ID 83301-3916
(208) 736-7090
(208) 736-7089
Mailing address
550 POLK ST, SUITE A, TWIN FALLS, ID 83301-3916
(208) 736-7090
(208) 736-7089
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
ID
Enumeration date
04/14/2011
Last updated
04/14/2011
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