Provider Demographics
NPI:1114002656
Name:FRANCISCAN LIFE CENTER NETWORK
Entity Type:Organization
Organization Name:FRANCISCAN LIFE CENTER NETWORK
Other - Org Name:FRANCISCAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCP
Authorized Official - Phone:208-233-9383
Mailing Address - Street 1:1745 POCATELLO CREEK RD
Mailing Address - Street 2:PO BOX 2955
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2308
Mailing Address - Country:US
Mailing Address - Phone:208-233-9383
Mailing Address - Fax:208-233-2707
Practice Address - Street 1:1745 POCATELLO CREEK RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2308
Practice Address - Country:US
Practice Address - Phone:208-233-9383
Practice Address - Fax:208-233-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPCP-203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty