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General NPI Number Information
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NPI Number | 1760940639
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Entity Type | Organization
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Legal Business Name | ADVOCACY CENTER
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Dates
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Enumeration Date | 03/08/2019
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 2429 JAFER CT
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City | IDAHO FALLS
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State | ID
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Zip | 83404-5587
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Country | US
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Telephone | 208-712-7077
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Fax | 208-384-9057
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Provider Business Mailing Address
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Address Line | 3270 E 17TH ST STE 261
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City | AMMON
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State | ID
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Zip | 83406-6758
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Country | US
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Telephone | 208-712-7077
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Fax | 208-384-9057
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OWNER
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Name | GARRETT SMITH
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Credential |
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Telephone | 208-346-3926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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