BANNOCK YOUTH FOUNDATION NPI 1245665470

NPI Information

BANNOCK YOUTH FOUNDATION is an addiction (substance use disorder) counselor in Pocatello, ID. BANNOCK YOUTH FOUNDATION NPI is 1245665470. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As M.k. Place.

The provider's business location address is:

110 SOUTH 19TH
POCATELLO, ID
ZIP 83201
Phone: (208) 234-4722
Fax: (208) 234-2135

The provider's authorized official is Cindy K Hansen .
The authorized official title is Clinical Director and has the following contact phone number (208) 234-4722.

The enumeration date for this NPI number is 9/6/2013 and was last updated on 9/6/2013.

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:

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