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General NPI Number Information
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NPI Number | 1003937962
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Entity Type | Organization
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Legal Business Name | CLEARWATER COUNSELING
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 112 WEST 4TH #5
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City | MOSCOW
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State | ID
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Zip | 83843
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Country | US
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Telephone | 208-882-9460
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Fax | 208-746-7402
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Provider Business Mailing Address
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Address Line | P.O. BOX 1123
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City | LEWISTON
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State | ID
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Zip | 83501
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Country | US
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Telephone | 208-743-8101
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Fax | 208-746-7402
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Authorized Official
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Title or Position | OWNER
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Name | MARK R JONES
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Credential | LCSW
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Telephone | 208-743-8101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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