| Summit Creek Counseling Llc | |
|
57 Bannock St Malad City ID 83252-1240 | |
| (208) 220-6534 | |
| Not Available |
| Full Name | Summit Creek Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 57 Bannock St, Malad City, Idaho |
| Authorized Official Name and Position | Jodie Barnes (MANAGER/MEMBER) |
| Authorized Official Contact | 2082206534 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Summit Creek Counseling Llc Po Box 35 Downey ID 83234-0035 Ph: (208) 220-6534 | Summit Creek Counseling Llc 57 Bannock St Malad City ID 83252-1240 Ph: (208) 220-6534 |
| NPI Number | 1609415199 |
|---|---|
| Provider Enumeration Date | 12/31/2019 |
| Last Update Date | 12/31/2019 |
| Certification Date | 12/31/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609415199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
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