Organization
SUZANNE GODFREY
Active
Parent organization
CLUB, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CLUB, INC.
Authorized official
MARDEE HARPER (EXECUTIVE DIRECTOR)
(208) 529-4673
Entity
Organization
Contact information
Practice address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 529-4673
(208) 529-4676
Mailing address
2001 S WOODRUFF AVE STE 6, IDAHO FALLS, ID 83404-6371
(208) 529-4673
(208) 529-4676
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC-4355
ID
Other
Enumeration date
09/11/2009
Last updated
09/11/2009
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