Organization
ANSWERS AND ALTERNATIVES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS ROBERT VAN FOSSEN M.ED., M.S. (OWNER)
(208) 245-4363
Entity
Organization
Contact information
Practice address
622 W COLLEGE AVE, ST MARIES, ID 83861-1822
(208) 245-4363
(208) 245-4349
Mailing address
PO BOX 533, ST MARIES, ID 83861-0533
(208) 245-4363
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC-2700
ID
Other
Enumeration date
01/31/2007
Last updated
08/22/2020
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