| Lifespan Family Practice Mental Health Clinic | |
|
550 Polk St Suite A Twin Falls ID 83301-3916 | |
| (208) 736-7090 | |
| (208) 736-7089 |
| Full Name | Lifespan Family Practice Mental Health Clinic |
|---|---|
| Speciality | Behavior Analyst |
| Location | 550 Polk St, Twin Falls, Idaho |
| Authorized Official Name and Position | Wendy L Mcknight (OWNER) |
| Authorized Official Contact | 2087367090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifespan Family Practice Mental Health Clinic 550 Polk St Suite A Twin Falls ID 83301-3916 Ph: (208) 736-7090 | Lifespan Family Practice Mental Health Clinic 550 Polk St Suite A Twin Falls ID 83301-3916 Ph: (208) 736-7090 |
| NPI Number | 1821388505 |
|---|---|
| Provider Enumeration Date | 04/14/2011 |
| Last Update Date | 04/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821388505 | NPI | - | NPPES |
| PENDING | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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