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General NPI Number Information
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NPI Number | 1912333238
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Entity Type | Organization
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Legal Business Name | FAMILY SERVICES COUNSELING CENTER
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 704 ALBANY ST
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City | CALDWELL
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State | ID
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Zip | 83605-3501
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Country | US
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Telephone | 208-454-5133
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Fax | 208-454-0749
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Provider Business Mailing Address
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Address Line | 704 ALBANY ST
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City | CALDWELL
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State | ID
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Zip | 83605-3501
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Country | US
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Telephone | 208-454-5133
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Fax | 208-454-0749
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HECTOR DE LEON
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Credential | LSW, MSW, CADC
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Telephone | 208-454-5133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 6817
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6817
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License Number State | ID
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