Organization
GATEWAY COUNSELING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. COREY LYNN RICHARDSON LCSW (OPERATIONS DIRECTOR)
(208) 242-3771
Entity
Organization
Contact information
Practice address
427 N MAIN ST, SUITE 101, POCATELLO, ID 83204-3016
(208) 242-3771
(208) 242-3772
Mailing address
427 N MAIN ST, SUITE 101, POCATELLO, ID 83204-3016
(208) 242-3771
(208) 242-3772
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LCSW-28906
ID
104100000X
Social Worker
Primary
LCSW-28906
ID
Other
Enumeration date
06/08/2011
Last updated
08/24/2011
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