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General NPI Number Information
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NPI Number | 1598405797
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Entity Type | Organization
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Legal Business Name | A JOURNEY TO A NEW BEGINNING
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Dates
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Enumeration Date | 03/29/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 214 E CENTER ST STE 40
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City | POCATELLO
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State | ID
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Zip | 83201-6372
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Country | US
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Telephone | 208-545-7966
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Fax | 208-241-6215
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Provider Business Mailing Address
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Address Line | 214 E CENTER ST STE 40
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City | POCATELLO
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State | ID
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Zip | 83201-6372
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Country | US
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Telephone | 208-545-7966
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Fax | 208-241-6215
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Authorized Official
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Title or Position | OWNER
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Name | DEANNA S SMITH
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Credential | LCSW
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Telephone | 208-241-7681
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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 |
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License Number State |
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