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General NPI Number Information
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NPI Number | 1033573993
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Entity Type | Organization
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Legal Business Name | THERAPY IN MOTION INC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 178 WEST MAIN STREET
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City | LAVA HOT SPRINGS
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State | ID
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Zip | 83246
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Country | US
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Telephone | 208-776-5125
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 404
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City | LAVA HOT SPRINGS
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State | ID
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Zip | 83246-0404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOHN CHARLES FLEMING
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Credential | LCSW
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Telephone | 208-776-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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