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General NPI Number Information
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NPI Number | 1558763490
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Entity Type | Organization
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Legal Business Name | DEAN COUNSELING INC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 2635 CHANNING WAY SUITE B
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7518
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Country | US
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Telephone | 208-680-6488
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Fax | 208-523-8978
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Provider Business Mailing Address
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Address Line | 3820 E 180 N
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City | RIGBY
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State | ID
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Zip | 83442-5775
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Country | US
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Telephone | 208-680-6488
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Fax | 208-523-8978
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Authorized Official
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Title or Position | OWNER
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Name | TRAVIS A DEAN
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Credential | LCSW
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Telephone | 208-680-6488
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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 | LCSW-27235
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License Number State | ID
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