Provider Demographics
NPI:1295825115
Name:ASSOCIATED COUNSELING
Entity Type:Organization
Organization Name:ASSOCIATED COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD MA LCPC
Authorized Official - Phone:208-523-5991
Mailing Address - Street 1:2539 CHANNING WAY
Mailing Address - Street 2:SUITE #240
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-523-5991
Mailing Address - Fax:208-523-5991
Practice Address - Street 1:2539 CHANNING WAY
Practice Address - Street 2:SUITE #240
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7544
Practice Address - Country:US
Practice Address - Phone:208-523-5991
Practice Address - Fax:208-523-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID105LCPC261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805715800Medicaid