Provider Demographics
NPI:1467268953
Name:LC-ADVANCED HEALTH & WELLNESS
Entity type:Organization
Organization Name:LC-ADVANCED HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CADC
Authorized Official - Phone:208-816-0015
Mailing Address - Street 1:1428 G ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2031
Mailing Address - Country:US
Mailing Address - Phone:208-848-4140
Mailing Address - Fax:208-848-4143
Practice Address - Street 1:1428 G ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2031
Practice Address - Country:US
Practice Address - Phone:208-848-4140
Practice Address - Fax:208-848-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty