MEDICARE: FAMILY HARMONY, LLC

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	101YM0800X	Mental Health Counselor	LCSW-29269	ID

General Provider Information

NPI Number	:	1588010615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HARMONY, LLC

Provider Business Mailing Address
First Line	:	2922 CLEVELAND BLVD
Second Line	:	SUITE 500
City	:	CALDWELL
State	:	ID
Zip	:	83605-4436
Country	:	US
Telephone Number	:	208-453-2728
Fax Number	:	208-455-1474

Provider Business Practice Location Address
First Line	:	2922 CLEVELAND BLVD
Second Line	:	SUITE 500
City	:	CALDWELL
State	:	ID
Zip	:	83605-4436
Country	:	US
Telephone Number	:	208-453-2728
Fax Number	:	208-455-1474

Authorized Official
Title or Position	:	CEO/ CLINICAIN
Name	:	ELIZABETH MCDOUGALL
Credential	:	LCSW
Telephone Number	:	208-453-2728

Provider Enumeration Date	:	05/07/2016
Last Update Date	:	05/07/2016

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