Provider Demographics
NPI:1063837003
Name:REDFORD COUNSELING AND FAMILY SERVICES
Entity Type:Organization
Organization Name:REDFORD COUNSELING AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:ROBB
Authorized Official - Last Name:REDFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-604-0098
Mailing Address - Street 1:1501 BENCH RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 BENCH RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2443
Practice Address - Country:US
Practice Address - Phone:208-242-3044
Practice Address - Fax:208-904-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW - 26140261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)