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General NPI Number Information
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NPI Number | 1740835834
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Entity Type | Organization
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Legal Business Name | CRT CHILDREN SERVICES LLC
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 212 RODEO DR STE 510
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City | MOSCOW
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State | ID
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Zip | 83843-9795
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Country | US
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Telephone | 208-874-8002
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Fax | 208-596-4010
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Provider Business Mailing Address
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Address Line | PO BOX 3491
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City | MOSCOW
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State | ID
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Zip | 83843-1912
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Country | US
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Telephone | 208-340-2370
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CALVIN ROGER STOWE
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Credential |
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Telephone | 208-340-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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