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General NPI Number Information
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NPI Number | 1700651221
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Entity Type | Organization
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Legal Business Name | JUST 4 KIDS HEALTH LLC
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2105 CORONADO STREET
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City | IDAHO FALLS
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State | ID
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Zip | 83404
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Country | US
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Telephone | 208-534-7881
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Fax | 208-242-4464
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Provider Business Mailing Address
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Address Line | PO BOX 1407
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1407
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Country | US
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Telephone | 208-701-0277
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AARON HOWARD GARDNER
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Credential | MD
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Telephone | 208-534-7881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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