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General NPI Number Information
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NPI Number | 1205863222
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Entity Type | Organization
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Legal Business Name | FAMILY CARE CENTER, INC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 1582 N HOLMES AVENUE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-2032
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Country | US
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Telephone | 208-524-8832
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Fax | 208-535-7595
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Provider Business Mailing Address
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Address Line | 1582 N HOLMES AVENUE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-2032
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Country | US
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Telephone | 208-529-8832
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Fax | 208-535-7595
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOHN OAKLEY
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Credential | LCPC
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Telephone | 20852988332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | ID
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