Provider Demographics
NPI:1407224744
Name:RECOVER.HE COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:RECOVER.HE COUNSELING & CONSULTING
Other - Org Name:ADDICTION & TRAUMA RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-881-0518
Mailing Address - Street 1:1970 E 17TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:808-881-0518
Mailing Address - Fax:208-881-0513
Practice Address - Street 1:1970 E 17TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:808-881-0518
Practice Address - Fax:208-881-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-34822251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health