| Cognitive Restructuring, Llc Php | |
|
707 N 7th Ave Ste D Pocatello ID 83201-5796 | |
| (208) 242-3044 | |
| Not Available |
| Full Name | Cognitive Restructuring, Llc Php |
|---|---|
| Speciality | Clinic/Center |
| Location | 707 N 7th Ave Ste D, Pocatello, Idaho |
| Authorized Official Name and Position | Kenneth James Taylor (OWNER) |
| Authorized Official Contact | 2087570803 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cognitive Restructuring, Llc Php 707 N 7th Ave Ste D Pocatello ID 83201-5796 Ph: (208) 242-3044 | Cognitive Restructuring, Llc Php 707 N 7th Ave Ste D Pocatello ID 83201-5796 Ph: (208) 242-3044 |
| NPI Number | 1255971024 |
|---|---|
| Provider Enumeration Date | 01/09/2020 |
| Last Update Date | 05/04/2023 |
| Certification Date | 05/04/2023 |
| Medicare PECOS PAC ID | 9830510890 |
|---|---|
| Medicare Enrollment ID | O20200528003064 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255971024 | NPI | - | NPPES |
| Provider Name | Shellie M Waterman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801335633 PECOS PAC ID: 3274899554 Enrollment ID: I20171102003390 |
| Provider Name | Kenneth James Taylor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528565488 PECOS PAC ID: 7618390857 Enrollment ID: I20220723000076 |
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