| Icare Center For Change | |
|
1689 E 4000 N Buhl ID 83316-5647 | |
| (208) 918-2473 | |
| Not Available |
| Full Name | Icare Center For Change |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 1689 E 4000 N, Buhl, Idaho |
| Authorized Official Name and Position | Kelly Graff (OWNER, CLINICIAN) |
| Authorized Official Contact | 2089182473 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icare Center For Change 1689 E 4000 N Buhl ID 83316-5647 Ph: (208) 918-2473 | Icare Center For Change 1689 E 4000 N Buhl ID 83316-5647 Ph: (208) 918-2473 |
| NPI Number | 1508554940 |
|---|---|
| Provider Enumeration Date | 04/25/2023 |
| Last Update Date | 04/25/2023 |
| Certification Date | 04/25/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508554940 | NPI | - | NPPES |
| 1558567107 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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