Provider Type Icon

PORTNEUF VALLEY FAMILY CENTER NPI 1174629976


NPI Information

NPI: 1174629976
Provider Name: PORTNEUF VALLEY FAMILY CENTER
Classification: Counselor - 101Y00000X
Entity Type: Organization
Address:
444 HOSPITAL WAY STE 477
POCATELLO, ID
ZIP 83201
Phone: (208) 233-7832
Get Directions

PORTNEUF VALLEY FAMILY CENTER is a counselor in Pocatello, ID. The provider is a provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification. PORTNEUF VALLEY FAMILY CENTER NPI is 1174629976. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

444 HOSPITAL WAY STE 477
POCATELLO, ID
ZIP 83201-744
Phone: (208) 233-7832
Fax: (208) 233-7835

The provider's authorized official is Robert Andrew De Wall .
The authorized official title is Owner/administrator and has the following contact phone number (208) 233-7832.

The enumeration date for this NPI number is 9/16/2006 and was last updated on 10/22/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1101Y00000XCounselorYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1807338300MEDICAIDIDAHO
2807319500MEDICAIDIDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.