Provider Demographics
NPI:1154668796
Name:SUSAN F. FALCK, MSW, LCSW, PC
Entity Type:Organization
Organization Name:SUSAN F. FALCK, MSW, LCSW, PC
Other - Org Name:PLAYWORKS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWMER/PRESIDENT/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-946-9572
Mailing Address - Street 1:PO BOX 1837
Mailing Address - Street 2:7583 MAIN ST
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-1837
Mailing Address - Country:US
Mailing Address - Phone:208-946-9572
Mailing Address - Fax:208-267-9020
Practice Address - Street 1:7583 MAIN ST
Practice Address - Street 2:HAWKINS HOUSE HEALING CENTER
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-1837
Practice Address - Country:US
Practice Address - Phone:208-946-9572
Practice Address - Fax:208-267-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1376861138Medicaid