Provider Demographics
NPI:1154639714
Name:EARTHERAPY
Entity type:Organization
Organization Name:EARTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHOEN-ORR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-528-6853
Mailing Address - Street 1:354 W SUNNYSIDE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-4644
Mailing Address - Country:US
Mailing Address - Phone:208-528-6853
Mailing Address - Fax:208-528-6888
Practice Address - Street 1:354 W SUNNYSIDE RD
Practice Address - Street 2:SUITE D
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4644
Practice Address - Country:US
Practice Address - Phone:208-528-6853
Practice Address - Fax:208-528-6888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3187261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health