Healthcare Provider Details

I. General information

NPI: 1750212692
Provider Name (Legal Business Name): FAMILY FOOTSTEPS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 GRANT AVE
TWIN FALLS ID
83301-4021
US

IV. Provider business mailing address

789 GRANT AVE
TWIN FALLS ID
83301-4021
US

V. Phone/Fax

Practice location:
  • Phone: 208-751-1015
  • Fax:
Mailing address:
  • Phone: 208-751-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID DIXON
Title or Position: PRESIDENT
Credential: LCPC
Phone: 208-490-4072