Organization
LEAN ON ME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNA LEIGH DAVENPORT BS (OWNER)
(208) 716-2944
Entity
Organization
Contact information
Practice address
150 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4335
(208) 522-2522
(208) 522-2527
Mailing address
150 N WOODRUFF AVE, IDAHO FALLS, ID 83401-4335
(208) 522-2522
(208) 522-2527
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861765620
—
ID
Enumeration date
02/09/2012
Last updated
03/01/2012
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