Provider Demographics
NPI:1982758751
Name:COUNSELING CENTER
Entity type:Organization
Organization Name:COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKSTADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-543-4494
Mailing Address - Street 1:233 GOODING ST N
Mailing Address - Street 2:STE D
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6179
Mailing Address - Country:US
Mailing Address - Phone:208-732-0405
Mailing Address - Fax:208-543-2828
Practice Address - Street 1:233 GOODING ST N
Practice Address - Street 2:STE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6179
Practice Address - Country:US
Practice Address - Phone:208-732-0405
Practice Address - Fax:208-543-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT2991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty