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General NPI Number Information
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NPI Number | 1588942304
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Entity Type | Organization
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Legal Business Name | HIGHER CONNECTION INC
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 823 CENTER AVE
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City | PAYETTE
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State | ID
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Zip | 83661-2535
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Country | US
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Telephone | 208-642-3396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3482
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City | POST FALLS
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State | ID
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Zip | 83877-3482
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Country | US
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Telephone | 208-642-3396
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Fax | 208-642-9060
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Authorized Official
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Title or Position | OWNER
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Name | BEATRICE CARROLL
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Credential | LCSW
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Telephone | 208-642-3396
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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-1159
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License Number State | ID
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