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General NPI Number Information
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NPI Number | 1154668796
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Entity Type | Organization
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Legal Business Name | SUSAN F. FALCK, MSW, LCSW, PC
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 7583 MAIN ST HAWKINS HOUSE HEALING CENTER
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City | BONNERS FERRY
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State | ID
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Zip | 83805-1837
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Country | US
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Telephone | 208-946-9572
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Fax | 208-267-9020
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Provider Business Mailing Address
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Address Line | PO BOX 1837 7583 MAIN ST
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City | BONNERS FERRY
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State | ID
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Zip | 83805-1837
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Country | US
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Telephone | 208-946-9572
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Fax | 208-267-9020
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Authorized Official
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Title or Position | OWMER/PRESIDENT/PROVIDER
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Name | SUSAN FALCK
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Credential | LCSW
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Telephone | 208-946-9572
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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