| Mr John P Condron, MS, LCPC | |
|
1023 Yellowstone Ave Ste J, Pocatello, ID 83201-4478 | |
| (208) 233-1276 | |
| (208) 233-0835 |
| Full Name | Mr John P Condron |
|---|---|
| Gender | Male |
| Speciality | Counselor - Mental Health |
| Location | 1023 Yellowstone Ave Ste J, Pocatello, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972710564 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | LCPC-3868 (Idaho) | Primary |
| Entity Name | Willow Sage Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1538611652 PECOS PAC ID: 8527341007 Enrollment ID: O20170207001660 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr John P Condron, MS, LCPC 1023 Yellowstone Ave Ste J, Pocatello, ID 83201-4478 Ph: (208) 233-1276 | Mr John P Condron, MS, LCPC 1023 Yellowstone Ave Ste J, Pocatello, ID 83201-4478 Ph: (208) 233-1276 |
Ms. Dedra Christine Sanna, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 409 Washington Ave, Pocatello, ID 83201 Phone: 208-234-2646 Fax: 208-232-0035 | |
Courtney Moore, Counselor Medicare: Not Enrolled in Medicare Practice Location: 2055 Garrett Way, Ste 2, Pocatello, ID 83201 Phone: 208-233-7832 | |
Christina Strauch, SE Counselor Medicare: Not Enrolled in Medicare Practice Location: 1246 Yellowstone Ave Ste C5, Pocatello, ID 83201 Phone: 208-233-0150 Fax: 208-233-0159 | |
Lisa Hall, Counselor Medicare: Not Enrolled in Medicare Practice Location: 101 S Main St, Pocatello, ID 83204 Phone: 208-232-8840 | |
Ms. Rit Larae Nauman, LCPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 3330 Highway 30 W, Pocatello, ID 83201 Phone: 208-234-9100 Fax: 208-234-9104 | |
Michael L Stevens, LCSW Counselor Medicare: Accepting Medicare Assignments Practice Location: 109 N Arthur Ave Ste 203, Pocatello, ID 83204 Phone: 208-234-4673 Fax: 208-234-4677 | |
Mrs. Cassidy Michelle Roske, LPC Counselor Medicare: Not Enrolled in Medicare Practice Location: 409 Washington Ave, Pocatello, ID 83201 Phone: 208-234-2646 Fax: 208-232-0035 |