| Positive Connections, Llc | |
|
417 Shoup Ave W Twin Falls ID 83301-5028 | |
| (208) 737-9999 | |
| (208) 736-4400 |
| Full Name | Positive Connections, Llc |
|---|---|
| Speciality | Counselor |
| Location | 417 Shoup Ave W, Twin Falls, Idaho |
| Authorized Official Name and Position | Cynthia Lynn Opdycke (OWNER/PARTNER) |
| Authorized Official Contact | 2087379999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Connections, Llc Po Box 5995 Twin Falls ID 83303-5995 Ph: (208) 737-9999 | Positive Connections, Llc 417 Shoup Ave W Twin Falls ID 83301-5028 Ph: (208) 737-9999 |
| NPI Number | 1942301106 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 08/10/2011 |
| Medicare PECOS PAC ID | 3971822313 |
|---|---|
| Medicare Enrollment ID | O20150506000548 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942301106 | NPI | - | NPPES |
| 1942301106 | Medicaid | ID | |
| 1407989171 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Ravae J Minton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134220312 PECOS PAC ID: 1557334471 Enrollment ID: I20040818000241 |
| Provider Name | Lisa Leazenby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437124658 PECOS PAC ID: 4587983929 Enrollment ID: I20150506000634 |
| Provider Name | Cynthia Lynn Opdycke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043301617 PECOS PAC ID: 5799004131 Enrollment ID: I20151211000465 |
| Provider Name | William Alexander Dobson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1245331578 PECOS PAC ID: 2062700933 Enrollment ID: I20161007001508 |
| Provider Name | Carol Lynn Layne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528452083 PECOS PAC ID: 7416210596 Enrollment ID: I20180424002913 |
| Provider Name | Jennifer Marie Benally |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720513682 PECOS PAC ID: 8426485228 Enrollment ID: I20200715003635 |
| Provider Name | Chester C Mardis |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114203031 PECOS PAC ID: 0648613026 Enrollment ID: I20240213003037 |
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