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General NPI Number Information
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NPI Number | 1184983488
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTHCARE & COUNSELING
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Dates
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Enumeration Date | 05/08/2012
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 3355 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-589-2365
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Fax |
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Provider Business Mailing Address
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Address Line | 3355 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-589-2365
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELIZABETH CAMERON
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Credential | NP
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Telephone | 208-589-2365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSWO1103
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | NP676A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP676A
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License Number State | ID
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