MEDICARE: HEALTHWORKS FAMILY CENTER, INC.

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
1	106H00000X	Marriage & Family Therapist	LMFT2678	ID

General Provider Information

NPI Number	:	1861413577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHWORKS FAMILY CENTER, INC.

Provider Business Mailing Address
First Line	:	31 W CENTER ST
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-1530
Country	:	US
Telephone Number	:	208-547-0047
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 W CENTER ST
Second Line	:
City	:	SODA SPRINGS
State	:	ID
Zip	:	83276-1530
Country	:	US
Telephone Number	:	208-547-0047
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MELISSA VOGEL
Credential	:	MS, LMFT, LCPC, CFLE
Telephone Number	:	208-547-0047

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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