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NPI Code Detail

MEDICARE: UPPER VALLEY RESOURCE & COUNSELING LLC

MEDICARE: UPPER VALLEY RESOURCE & COUNSELING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1366986408
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER VALLEY RESOURCE & COUNSELING LLC
Provider Business Mailing Address
First Line : PO BOX 4789
Second Line :
City : POCATELLO
State : ID
Zip : 83205-4789
Country : US
Telephone Number : 208-233-2025
Fax Number : 208-269-1226
Provider Business Practice Location Address
First Line : 1223 S RAILROAD AVE
Second Line :
City : SUGAR CITY
State : ID
Zip : 83448-5072
Country : US
Telephone Number : 208-359-2493
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DARRIN ROBERTSON
Credential : NP
Telephone Number : 208-233-2025
Provider Enumeration Date : 12/08/2016
Last Update Date : 01/03/2020

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Directions to “UPPER VALLEY RESOURCE & COUNSELING LLC ” Practice Location

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