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General NPI Number Information
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NPI Number | 1962613919
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Entity Type | Organization
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Legal Business Name | TETON VALLEY COUNSELING, INC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 35 NORTH 1ST
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City | DRIGGS
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State | ID
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Zip | 83422-1300
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Country | US
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Telephone | 208-354-5775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1290
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City | DRIGGS
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State | ID
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Zip | 83422-1300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | AMY SNELL
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Credential |
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Telephone | 208-354-5775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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