| Healthy Place Counseling Pocatello Llc | |
|
1023 Yellowstone Ave Ste. J Pocatello ID 83201-4478 | |
| (208) 233-1276 | |
| (208) 233-0835 |
| Full Name | Healthy Place Counseling Pocatello Llc |
|---|---|
| Speciality | Counselor |
| Location | 1023 Yellowstone Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Kirk Korenke (OWNER) |
| Authorized Official Contact | 2082004818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Place Counseling Pocatello Llc 1023 Yellowstone Ave Ste. J Pocatello ID 83201-4478 Ph: (208) 233-1276 | Healthy Place Counseling Pocatello Llc 1023 Yellowstone Ave Ste. J Pocatello ID 83201-4478 Ph: (208) 233-1276 |
| NPI Number | 1154464394 |
|---|---|
| Provider Enumeration Date | 02/15/2007 |
| Last Update Date | 02/26/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154464394 | NPI | - | NPPES |
| 807364700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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