| Bannock County Family Treatment Center | |
|
141 N 6th Ave Pocatello ID 83201-6209 | |
| (208) 236-7089 | |
| (208) 236-7097 |
| Full Name | Bannock County Family Treatment Center |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 141 N 6th Ave, Pocatello, Idaho |
| Authorized Official Name and Position | Kimberly Jo Andrew (CLINICAL DIRECTOR) |
| Authorized Official Contact | 2082367089 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bannock County Family Treatment Center 141 N 6th Ave Pocatello ID 83201-6209 Ph: (208) 236-7089 | Bannock County Family Treatment Center 141 N 6th Ave Pocatello ID 83201-6209 Ph: (208) 236-7089 |
| NPI Number | 1427437383 |
|---|---|
| Provider Enumeration Date | 05/26/2015 |
| Last Update Date | 05/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427437383 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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