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General NPI Number Information
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NPI Number | 1467617001
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Entity Type | Organization
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Legal Business Name | HEARTLAND COUNSELING CENTER INC
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 303 N 12TH AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4746
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Country | US
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Telephone | 208-251-2400
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Fax | 208-233-4224
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Provider Business Mailing Address
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Address Line | 303 N 12TH AVE
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City | POCATELLO
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State | ID
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Zip | 83201-4746
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Country | US
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Telephone | 208-251-2400
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Fax | 208-233-4224
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR
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Name | MS. CRETE BROWN
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Credential | MSW, LCSW
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Telephone | 208-251-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW-529
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License Number State | ID
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