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General NPI Number Information
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NPI Number | 1427834571
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Entity Type | Organization
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Legal Business Name | LUKE & SPENCER BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 09/05/2023
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 1904 JENNIE LEE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6159
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Country | US
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Telephone | 208-406-4822
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Fax |
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Provider Business Mailing Address
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Address Line | 1904 JENNIE LEE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6159
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID SPENCER
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Credential | MSW
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Telephone | 208-974-5200
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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 | 101YM0800X
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Taxonomy Name | Mental Health 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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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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