Organization
PHILLIPS RANCH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALISON GRACE AGGEN LPCC (OWNER/CLINICAL DIRECTOR)
(720) 495-0550
Entity
Organization
Contact information
Practice address
3067 MOSQUITO CREEK RD, CLARK FORK, ID 83811-9825
(720) 495-0550
Mailing address
640 CHAMPS RD, BONNERS FERRY, ID 83805-6219
(720) 495-0550
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
08/01/2024
Last updated
01/22/2025
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