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General NPI Number Information
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NPI Number | 1295825115
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Entity Type | Organization
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Legal Business Name | ASSOCIATED COUNSELING
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 2539 CHANNING WAY SUITE #240
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7544
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Country | US
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Telephone | 208-523-5991
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Fax | 208-523-5991
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Provider Business Mailing Address
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Address Line | 2539 CHANNING WAY SUITE #240
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-523-5991
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Fax | 208-523-5991
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOANNE CARNES
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Credential | PSYD MA LCPC
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Telephone | 208-523-5991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 105LCPC
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License Number State | ID
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