Healthcare Provider Details

I. General information

NPI: 1861544587
Provider Name (Legal Business Name): UPPER VALLEY RESOURCE AND COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 N 2ND W
REXBURG ID
83440-1515
US

IV. Provider business mailing address

36 N 2ND W
REXBURG ID
83440-1515
US

V. Phone/Fax

Practice location:
  • Phone: 208-359-0519
  • Fax: 208-359-2493
Mailing address:
  • Phone: 208-359-0519
  • Fax: 208-359-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateID

VIII. Authorized Official

Name: MRS. REBECCA HYMAS
Title or Position: ADMINISTRATOR
Credential: LSW
Phone: 208-359-0519