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General NPI Number Information
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NPI Number | 1063604593
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Entity Type | Organization
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Legal Business Name | ITS ALL ABOUT CHOICES
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 348 S 1ST AVE
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City | POCATELLO
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State | ID
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Zip | 83201-6414
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Country | US
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Telephone | 208-221-2357
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Fax | 208-235-1503
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Provider Business Mailing Address
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Address Line | 348 S 1ST AVE
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City | POCATELLO
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State | ID
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Zip | 83201-6414
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Country | US
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Telephone | 208-221-2357
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Fax | 208-235-1503
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Authorized Official
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Title or Position | OWNER
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Name | MR. SEAN F. TOMKINSON
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Credential | LMSW
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Telephone | 208-221-2357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | APPLIED FOR
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License Number State | ID
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