| Candlewood Family Counseling Center, Inc. | |
|
335 N Main St Pocatello ID 83204-3108 | |
| (208) 478-8340 | |
| (208) 478-8341 |
| Full Name | Candlewood Family Counseling Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 335 N Main St, Pocatello, Idaho |
| Authorized Official Name and Position | Ella Dingman (PRESIDENT, ADMINISTRATOR) |
| Authorized Official Contact | 2084788340 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Candlewood Family Counseling Center, Inc. Po Box 2306 Pocatello ID 83206-2306 Ph: (208) 478-8340 | Candlewood Family Counseling Center, Inc. 335 N Main St Pocatello ID 83204-3108 Ph: (208) 478-8340 |
| NPI Number | 1093911828 |
|---|---|
| Provider Enumeration Date | 06/27/2007 |
| Last Update Date | 02/19/2015 |
| Medicare PECOS PAC ID | 9335382860 |
|---|---|
| Medicare Enrollment ID | O20130830000260 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093911828 | NPI | - | NPPES |
| 1093911828 | Medicaid | ID | |
| 1588860308 | Medicaid | ID | |
| 1912103748 | Medicaid | ID | |
| 1174673305 | Other | ID | PRIVATE INSURANCE |
| 1831395656 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Idaho) | Primary |
| Provider Name | Nancy Wheeler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386787521 PECOS PAC ID: 6800023144 Enrollment ID: I20131212001462 |
| Provider Name | Victoria Bertler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710207238 PECOS PAC ID: 9133531049 Enrollment ID: I20201217002952 |
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