Provider Demographics
NPI:1477691434
Name:UPPER VALLEY RESOURCE AND COUNSELING CENTER
Entity Type:Organization
Organization Name:UPPER VALLEY RESOURCE AND COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-359-0519
Mailing Address - Street 1:1223 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:SUGAR CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83448-5072
Mailing Address - Country:US
Mailing Address - Phone:208-359-0519
Mailing Address - Fax:208-359-2493
Practice Address - Street 1:1223 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:SUGAR CITY
Practice Address - State:ID
Practice Address - Zip Code:83448-5072
Practice Address - Country:US
Practice Address - Phone:208-359-0519
Practice Address - Fax:208-359-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807382700Medicaid