Bannock County Family Treatment Center

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Legal business name

BANNOCK COUNTY FAMILY TREATMENT CENTER

Practice address

141 N 6TH Ave
Pocatello, ID 83201-6209

Phone

(208) 236-7089

Fax

(208) 236-7097

NPI assigned

May 26, 2015

Last updated

May 26, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

BANNOCK COUNTYAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kimberly Jo Andrew, LCPC

Title

Clinical Director

Phone

(208) 236-7089

Specialties & licenses 2

Addresses

Tax ID family

Bannock Co Ambulance Serv3 organizations share this tax ID, including this one

Part of

Bannock Co Ambulance Serv

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Bannock County Juvenile Justice

  • Case Management Agency
  • Pocatello, ID
  • NPI 1982895884
  NPD tax ID
• D6 Treatment

  • Addiction (Substance Use Disorder) Counselor
  • Pocatello, ID
  • NPI 1689218018
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432598400000",
    "number": "1427437383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 N 6TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016209",
            "telephone_number": "208-236-7089",
            "fax_number": "208-236-7097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 N 6TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016209",
            "telephone_number": "208-236-7089",
            "fax_number": "208-236-7097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNOCK COUNTY FAMILY TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNOCK COUNTY",
        "enumeration_date": "2015-05-26",
        "last_updated": "2015-05-26",
        "status": "A",
        "authorized_official_last_name": "ANDREW",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "208-236-7089",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Ensio Baker, D.D.S.
• Jenny May Ball, FNP
• Joette Ballard, PHARM D
• Ashley L Ballensky, RN
• Bannock County Ambulance District
• Bannock County Juvenile Justice
• Bannock Inpatient Services PLLC
• Bannock Youth Foundation (M.K. Place)
• Sarah Nicolle Baquet, LPC
• Daniel McLean Barclay, DPT

• Addiction (Substance Use Disorder) Counselor in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Addiction (Substance Use Disorder) Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.