| North Fork Counseling Services, Llc | |
|
2691 S 2000 W Rexburg ID 83440-4049 | |
| (208) 701-9616 | |
| Not Available |
| Full Name | North Fork Counseling Services, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2691 S 2000 W, Rexburg, Idaho |
| Authorized Official Name and Position | Jon Burnham (OWNER/MANAGER) |
| Authorized Official Contact | 2082011300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Fork Counseling Services, Llc Po Box 64 Sugar City ID 83448-0064 Ph: (208) 701-9616 | North Fork Counseling Services, Llc 2691 S 2000 W Rexburg ID 83440-4049 Ph: (208) 701-9616 |
| NPI Number | 1730873811 |
|---|---|
| Provider Enumeration Date | 06/02/2023 |
| Last Update Date | 06/02/2023 |
| Certification Date | 06/02/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730873811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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