Provider Demographics
NPI:1407566508
Name:IGNITIE IDAHO FAMILY RESOURCE CENTER INC
Entity Type:Organization
Organization Name:IGNITIE IDAHO FAMILY RESOURCE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:208-630-4200
Mailing Address - Street 1:106 E PARK ST STE 107
Mailing Address - Street 2:
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-5064
Mailing Address - Country:US
Mailing Address - Phone:208-630-4200
Mailing Address - Fax:
Practice Address - Street 1:106 E PARK ST STE 107
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-5064
Practice Address - Country:US
Practice Address - Phone:208-994-5537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty