Healthcare Provider Details

I. General information

NPI: 1154668796
Provider Name (Legal Business Name): SUSAN F. FALCK, MSW, LCSW, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7583 MAIN ST HAWKINS HOUSE HEALING CENTER
BONNERS FERRY ID
83805-1837
US

IV. Provider business mailing address

PO BOX 1837 7583 MAIN ST
BONNERS FERRY ID
83805-1837
US

V. Phone/Fax

Practice location:
  • Phone: 208-946-9572
  • Fax: 208-267-9020
Mailing address:
  • Phone: 208-946-9572
  • Fax: 208-267-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUSAN FALCK
Title or Position: OWMER/PRESIDENT/PROVIDER
Credential: LCSW
Phone: 208-946-9572