| Wild Life Community Counseling Pllc | |
|
264 Black Mountain Rd Bonners Ferry ID 83805-5308 | |
| (208) 416-3850 | |
| Not Available |
| Full Name | Wild Life Community Counseling Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 264 Black Mountain Rd, Bonners Ferry, Idaho |
| Authorized Official Name and Position | Dean Michael Jennings (LCSW) |
| Authorized Official Contact | 2084163850 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wild Life Community Counseling Pllc Po Box 172 Bonners Ferry ID 83805-0172 Ph: (208) 416-3850 | Wild Life Community Counseling Pllc 264 Black Mountain Rd Bonners Ferry ID 83805-5308 Ph: (208) 416-3850 |
| NPI Number | 1699413757 |
|---|---|
| Provider Enumeration Date | 05/26/2022 |
| Last Update Date | 01/11/2023 |
| Certification Date | 01/11/2023 |
| Medicare PECOS PAC ID | 4981068012 |
|---|---|
| Medicare Enrollment ID | O20230907004309 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699413757 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| Provider Name | Dean M Jennings |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831524537 PECOS PAC ID: 5092112045 Enrollment ID: I20210920000074 |
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