| Heartland Counseling Center Inc | |
|
303 N 12th Ave Pocatello ID 83201-4746 | |
| (208) 251-2400 | |
| (208) 233-4224 |
| Full Name | Heartland Counseling Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 303 N 12th Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Crete Brown (PRESIDENT/DIRECTOR) |
| Authorized Official Contact | 2082512400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heartland Counseling Center Inc 303 N 12th Ave Pocatello ID 83201-4746 Ph: (208) 251-2400 | Heartland Counseling Center Inc 303 N 12th Ave Pocatello ID 83201-4746 Ph: (208) 251-2400 |
| NPI Number | 1467617001 |
|---|---|
| Provider Enumeration Date | 07/23/2008 |
| Last Update Date | 10/29/2013 |
| Medicare PECOS PAC ID | 4789759531 |
|---|---|
| Medicare Enrollment ID | O20080813000830 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467617001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LCSW-529 (Idaho) | Primary |
| Provider Name | Crete Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407947096 PECOS PAC ID: 6507931342 Enrollment ID: I20080813000820 |
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