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General NPI Number Information
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NPI Number | 1851713473
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Entity Type | Organization
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Legal Business Name | INTEGRATED FAMILY & COMMUNITY SERVICES
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/16/2014
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Provider Practice Location Address
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Address Line | 3355 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-523-2080
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Fax | 208-523-2799
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Provider Business Mailing Address
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Address Line | 3355 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 208-523-2080
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Fax | 208-523-2799
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Authorized Official
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Title or Position | OWNER
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Name | LISA BRIDGES
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Credential | LCSW
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Telephone | 208-523-2080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LCSW1103
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW1103
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License Number State | ID
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