MEDICARE: BELL CHEMICAL DEPENDENCY OUNSELING INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		ID

General Provider Information

NPI Number	:	1407294697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELL CHEMICAL DEPENDENCY OUNSELING INC.

Provider Business Mailing Address
First Line	:	2719 S KIMBALL AVE
Second Line	:	P.O. BOX 1022 EMMETT, ID 83617
City	:	CALDWELL
State	:	ID
Zip	:	83605-5623
Country	:	US
Telephone Number	:	208-459-6557
Fax Number	:	208-453-8847

Provider Business Practice Location Address
First Line	:	2719 S KIMBALL AVE
Second Line	:
City	:	CALDWELL
State	:	ID
Zip	:	83605-5623
Country	:	US
Telephone Number	:	208-459-6557
Fax Number	:	208-453-8847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. DIANA M BELL
Credential	:	LCSW, LMFT
Telephone Number	:	208-459-6557

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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