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General NPI Number Information
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NPI Number | 1053705707
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Entity Type | Organization
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Legal Business Name | HEALTHIER BODIES
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Dates
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Enumeration Date | 03/19/2015
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 1904 ADDISON AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5304
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Country | US
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Telephone | 208-339-1756
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 ADDISON AVE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5304
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Country | US
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Telephone | 208-339-1756
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DENISE M JENSEN
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Credential | LPC, MT
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Telephone | 208-339-1756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | LPC 4914
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License Number State | ID
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