Provider Demographics
NPI:1528601440
Name:IDAHO FEDERTION OF FAMILIES
Entity Type:Organization
Organization Name:IDAHO FEDERTION OF FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DEVELOPMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-433-8845
Mailing Address - Street 1:704 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5503
Mailing Address - Country:US
Mailing Address - Phone:208-433-8845
Mailing Address - Fax:208-433-8337
Practice Address - Street 1:704 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5503
Practice Address - Country:US
Practice Address - Phone:208-433-8845
Practice Address - Fax:208-433-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty