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General NPI Number Information
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NPI Number | 1356569495
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Entity Type | Organization
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Legal Business Name | ALLSTAR COUNSELING SERVICES
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 550 2ND ST # 292
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3900
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Country | US
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Telephone | 208-200-7377
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Fax | 208-529-4647
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Provider Business Mailing Address
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Address Line | 550 2ND ST # 292 PO BOX 1876
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City | IDAHO FALLS
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State | ID
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Zip | 83401-3900
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Country | US
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Telephone | 208-200-7377
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Fax | 208-529-4647
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MANDY J. LUIS
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Credential | LSW
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Telephone | 208-200-7377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LSW-24674
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License Number State | ID
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