MEDICARE: THE CHILDREN'S CENTER

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010141601	OTHER	ID	REGENCE BLUE SHIELD
2	8L659	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1982719332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CHILDREN'S CENTER

Provider Business Mailing Address
First Line	:	1675 CURLEW DRIVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83406
Country	:	US
Telephone Number	:	208-529-4300
Fax Number	:	208-529-1627

Provider Business Practice Location Address
First Line	:	1675 CURLEW DRIVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83406
Country	:	US
Telephone Number	:	208-529-4300
Fax Number	:	208-529-1627

Authorized Official
Title or Position	:	BILLING SPECIALISTS
Name	:	MISS MAGGIE M SCHWEITZER
Credential	:
Telephone Number	:	208-529-4300

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/22/2020

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Directions to “THE CHILDREN'S CENTER ” Practice Location

Language	Start Address	Practice Location

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