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General NPI Number Information
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NPI Number | 1407566508
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Entity Type | Organization
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Legal Business Name | IGNITE IDAHO FAMILY RESOURCE CENTER INC
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 106 E PARK ST STE 227 227
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City | MCCALL
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State | ID
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Zip | 83638-5064
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Country | US
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Telephone | 208-994-5537
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Fax | 208-277-1877
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Provider Business Mailing Address
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Address Line | 106 E PARK ST STE 227
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City | MCCALL
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State | ID
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Zip | 83638-5069
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Country | US
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Telephone | 208-994-5537
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Fax | 208-227-1877
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. TRACI C JAMIESON
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Credential | LPC
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Telephone | 208-630-4200
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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 |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #5
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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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