Provider Demographics
NPI:1073662052
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES ID IDAHO FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAIGH
Authorized Official - Middle Name:H
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-529-5276
Mailing Address - Street 1:1600 JOHN ADAMS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4300
Mailing Address - Country:US
Mailing Address - Phone:208-529-5276
Mailing Address - Fax:208-529-6506
Practice Address - Street 1:1600 JOHN ADAMS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4300
Practice Address - Country:US
Practice Address - Phone:208-529-5276
Practice Address - Fax:208-529-6506
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-09
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID19643251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health