MEDICARE: SUZANNE GODFREY

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	101Y00000X	Counselor	LPC-4355	ID

General Provider Information

NPI Number	:	1982937736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE GODFREY

Provider Business Mailing Address
First Line	:	2001 S WOODRUFF AVE STE 6
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6371
Country	:	US
Telephone Number	:	208-529-4673
Fax Number	:	208-529-4676

Provider Business Practice Location Address
First Line	:	2001 S WOODRUFF AVE STE 6
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6371
Country	:	US
Telephone Number	:	208-529-4673
Fax Number	:	208-529-4676

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARDEE HARPER
Credential	:
Telephone Number	:	208-529-4673

Provider Enumeration Date	:	09/11/2009
Last Update Date	:	09/11/2009

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Directions to “SUZANNE GODFREY ” Practice Location

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