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562 Shoup Ave W Twin Falls ID 83301-5029 | |
| (208) 734-0407 | |
| (208) 734-3534 |
| Full Name | |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 562 Shoup Ave W, Twin Falls, Idaho |
| Authorized Official Name and Position | Lisa Colwell (OFFICE MANAGER) |
| Authorized Official Contact | 2087340407 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
562 Shoup Ave W Twin Falls ID 83301-5029 Ph: (208) 734-0407 | 562 Shoup Ave W Twin Falls ID 83301-5029 Ph: (208) 734-0407 |
| NPI Number | 1225139298 |
|---|---|
| Provider Enumeration Date | 09/25/2006 |
| Last Update Date | 08/22/2023 |
| Certification Date | 08/22/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225139298 | NPI | - | NPPES |
| 807373500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (Idaho) | Secondary |
| 101YM0800X | Counselor - Mental Health | (Idaho) | Primary |
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