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General NPI Number Information
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NPI Number | 1437680535
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Entity Type | Organization
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Legal Business Name | CIBRIAN COUNSELING & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 550 2ND ST SUITE 290
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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 | 208-970-7901
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Fax |
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Provider Business Mailing Address
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Address Line | 5103 RYANNE WAY
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City | IONA
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State | ID
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Zip | 83427-5105
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Country | US
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Telephone | 208-970-7901
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. LOUIE CIBRIAN
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Credential | LCSW
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Telephone | 208-970-7901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 36347
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License Number State | ID
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