| New Dawn Counseling, Llc | |
|
650 10th St Idaho Falls ID 83404-5067 | |
| (208) 552-9174 | |
| (208) 552-9175 |
| Full Name | New Dawn Counseling, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 650 10th St, Idaho Falls, Idaho |
| Authorized Official Name and Position | Lisa Calderwood (OWNER/MANAGER) |
| Authorized Official Contact | 2085529174 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| New Dawn Counseling, Llc 3509 Greenfield Dr Ammon ID 83406-7612 Ph: (208) 552-9174 | New Dawn Counseling, Llc 650 10th St Idaho Falls ID 83404-5067 Ph: (208) 552-9174 |
| NPI Number | 1912182163 |
|---|---|
| Provider Enumeration Date | 01/07/2008 |
| Last Update Date | 02/05/2023 |
| Certification Date | 02/05/2023 |
| Medicare PECOS PAC ID | 1951455278 |
|---|---|
| Medicare Enrollment ID | O20090820000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912182163 | NPI | - | NPPES |
| 1912182163 | Medicaid | ID | |
| 1912182163 | Other | ID | MEDICARE PART B |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW-27801 (Idaho) | Primary |
| 251S00000X | Community/behavioral Health | LCSW-27801 (Idaho) | Secondary |
| Provider Name | Lisa D Calderwood |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467574442 PECOS PAC ID: 8325192644 Enrollment ID: I20090820000204 |
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