| Candlewood Family Counseling Center, Inc. | |
|
335 N Main St Pocatello ID 83204-3108 | |
| (208) 478-8340 | |
| (208) 478-8341 |
| Full Name | Candlewood Family Counseling Center, Inc. |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 335 N Main St, Pocatello, Idaho |
| Authorized Official Name and Position | Ella Dingman (ADMINSTRATOR) |
| Authorized Official Contact | 2084788340 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Candlewood Family Counseling Center, Inc. 335 N Main St Pocatello ID 83204-3108 Ph: (208) 478-8340 | Candlewood Family Counseling Center, Inc. 335 N Main St Pocatello ID 83204-3108 Ph: (208) 478-8340 |
| NPI Number | 1174673305 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 01/16/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174673305 | NPI | - | NPPES |
| 1093911828 | Medicaid | ID | |
| 1912103748 | Medicaid | ID | |
| 1831395656 | Medicaid | ID | |
| 1588860308 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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