=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619562980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARMONY COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2021
-----------------------------------------------------
Last Update Date | 03/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 482 CONSTITUTION WAY STE 106
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83402-3568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-206-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 E 1270 N
-----------------------------------------------------
City | SHELLEY
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83274-4902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-206-2864
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. TIMMIE LYN JOHN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 208-206-2864
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------