| Club Inc | |
|
2001 S Woodruff Suite 6 Idaho Falls ID 83404 | |
| (208) 529-4673 | |
| (208) 529-4676 |
| Full Name | Club Inc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2001 S Woodruff, Idaho Falls, Idaho |
| Authorized Official Name and Position | Kristee Criddle (LNSW) |
| Authorized Official Contact | 2082411377 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Club Inc 2001 S Woodruff Ave Suite 6 Idaho Falls ID 83404-6374 Ph: () - | Club Inc 2001 S Woodruff Suite 6 Idaho Falls ID 83404 Ph: (208) 529-4673 |
| NPI Number | 1871915694 |
|---|---|
| Provider Enumeration Date | 01/14/2014 |
| Last Update Date | 01/14/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871915694 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | LMSW-30202 (Idaho) | Primary |
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