Candlewood Family Counseling Center, Inc.
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Pocatello, ID
NPI 1174673305 · NPPES record last updated Jan 16, 2013
Key facts
- NPI
- 1174673305
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- CANDLEWOOD FAMILY COUNSELING CENTER, INC.
- Practice address
- 335 N Main St
Pocatello, ID 83204-3108 - Phone
- (208) 478-8340
- Fax
- (208) 478-8341
- NPI assigned
- Jan 11, 2007
- Organization subpart
- No
Authorized official
- Name
- Mrs. Ella Dingman, LCSW
- Title
- Adminstrator
- Phone
- (208) 478-8340
Corporate family (same tax ID) 5
National Provider Directory
- Tax ID family
- Candlewood Family Counseling Center Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
335 N Main St
Pocatello, ID 83204-3108
Mailing address
335 N Main St
Pocatello, ID 83204-3108
Phone (208) 478-8340
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093911828 | Medicaid | ID | |
| 1912103748 | Medicaid | ID | |
| 1831395656 | Medicaid | ID | |
| 1588860308 | Medicaid | ID |
Other providers in Pocatello, ID
- Marlene Cameron
- James Matthew Campbell
- Tiffany Campbell
- Trinety Lynn Campbell
- Candlewood Family Counseling Center, Inc.
- Candlewood Family Counseling Center, Inc.
- Candlewood Family Counseling Center, Inc.
- Candlewood Family Counseling Center, Inc.
- Candlewood Family Counseling Center, Inc.
- Candlewood Family Counseling Center, Inc.
All providers in Pocatello, ID · Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.