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General NPI Number Information
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NPI Number | 1972049427
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Entity Type | Organization
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Legal Business Name | STEPPING STONES COUNSELING AND MEDIATION LLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1140 N MINK CREEK RD
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City | POCATELLO
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State | ID
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Zip | 83204-7250
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Country | US
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Telephone | 208-705-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 NORTH MINK CREEK
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City | POCATELLO
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State | ID
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Zip | 83204
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Country | US
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Telephone | 208-705-0771
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDA JEAN CANTRELL
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Credential | LCSW
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Telephone | 208-705-0771
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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 | LCSW28640
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License Number State | ID
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