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General NPI Number Information
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NPI Number | 1942956073
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Entity Type | Organization
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Legal Business Name | NURTURING CONNECTIONS THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 2539 CHANNING WAY STE 101
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7557
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Country | US
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Telephone | 208-251-6103
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Fax |
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Provider Business Mailing Address
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Address Line | 2184 CHANNING WAY STE 308
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8034
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Country | US
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Telephone | 208-251-6103
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. STEFANIE WESTOVER
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Credential | LMSW
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Telephone | 208-557-3336
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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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