Healthcare Provider Details

I. General information

NPI: 1700651221
Provider Name (Legal Business Name): JUST 4 KIDS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 CORONADO STREET
IDAHO FALLS ID
83404
US

IV. Provider business mailing address

PO BOX 1407
IDAHO FALLS ID
83403-1407
US

V. Phone/Fax

Practice location:
  • Phone: 208-534-7881
  • Fax: 208-242-4464
Mailing address:
  • Phone: 208-534-7881
  • Fax: 208-203-7067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: AARON HOWARD GARDNER
Title or Position: OWNER
Credential: MD
Phone: 208-534-7881