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General NPI Number Information
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NPI Number | 1912059361
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Entity Type | Organization
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Legal Business Name | CONFLUENCE COUNSELING AND EDUCATION CENTER, LLC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 111 MAIN ST SUITE 302
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City | LEWISTON
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State | ID
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Zip | 83501-2141
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Country | US
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Telephone | 208-798-5132
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Fax | 208-798-5143
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Provider Business Mailing Address
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Address Line | 111 MAIN ST SUITE 302
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City | LEWISTON
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State | ID
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Zip | 83501-2141
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Country | US
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Telephone | 208-798-5132
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Fax | 208-798-5143
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LAFAWN M HAMM
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Credential | LCSW
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Telephone | 208-798-5132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1109
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License Number State | ID
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