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General NPI Number Information
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NPI Number | 1528366424
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Entity Type | Organization
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Legal Business Name | GATEWAY COUNSELING INCORPORATED
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 151 N 3RD AVE STE 330
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City | POCATELLO
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State | ID
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Zip | 83201-6331
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Country | US
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Telephone | 208-242-3771
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Fax | 208-242-3772
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Provider Business Mailing Address
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Address Line | 151 N 3RD AVE STE 330
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City | POCATELLO
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State | ID
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Zip | 83201-6331
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Country | US
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Telephone | 208-242-3771
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Fax | 208-242-3772
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Authorized Official
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Title or Position | OWNER
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Name | COREY LYNN RICHARDSON
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Credential | LCSW
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Telephone | 208-242-3771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | ID
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | ID
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Taxonomy #3
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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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