| Personal Growth Center | |
|
211 S Woodruff Idaho Falls ID 83401 | |
| (208) 529-5548 | |
| (208) 529-5588 |
| Full Name | Personal Growth Center |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 211 S Woodruff, Idaho Falls, Idaho |
| Authorized Official Name and Position | Michael Jon Harris (DIRECTOR) |
| Authorized Official Contact | 2085295548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Personal Growth Center 211 S Woodruff Suite A4 Idaho Falls ID 83401 Ph: (208) 529-5548 | Personal Growth Center 211 S Woodruff Idaho Falls ID 83401 Ph: (208) 529-5548 |
| NPI Number | 1255478293 |
|---|---|
| Provider Enumeration Date | 01/31/2007 |
| Last Update Date | 10/07/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255478293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LCSW420 (Idaho) | Primary |
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