| Addiction & Trauma Recovery Services | |
|
1970 E 17th St Suite 203 Idaho Falls ID 83404 | |
| (808) 881-0518 | |
| (208) 881-0513 |
| Full Name | Addiction & Trauma Recovery Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1970 E 17th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Sheila Kellog (OFFICE MANAGER) |
| Authorized Official Contact | 2088810518 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Addiction & Trauma Recovery Services 1970 E 17th St Suite 203 Idaho Falls ID 83404 Ph: (808) 881-0518 | Addiction & Trauma Recovery Services 1970 E 17th St Suite 203 Idaho Falls ID 83404 Ph: (808) 881-0518 |
| NPI Number | 1407224744 |
|---|---|
| Provider Enumeration Date | 09/03/2015 |
| Last Update Date | 02/08/2021 |
| Certification Date | 02/08/2021 |
| Medicare PECOS PAC ID | 8527361203 |
|---|---|
| Medicare Enrollment ID | O20160129002358 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407224744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW-34822 (Idaho) | Primary |
| Provider Name | Kelly Marie Mcmurtrey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356656441 PECOS PAC ID: 6103143441 Enrollment ID: I20150325000503 |
| Provider Name | Megan S Wall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962881482 PECOS PAC ID: 2365746872 Enrollment ID: I20160203001885 |
| Provider Name | Sara J Hiatt |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811358195 PECOS PAC ID: 6901184449 Enrollment ID: I20161103001481 |
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