Provider Demographics
NPI:1558763490
Name:DEAN COUNSELING INC
Entity Type:Organization
Organization Name:DEAN COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-680-6488
Mailing Address - Street 1:3820 E 180 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5775
Mailing Address - Country:US
Mailing Address - Phone:208-680-6488
Mailing Address - Fax:208-523-8978
Practice Address - Street 1:2635 CHANNING WAY
Practice Address - Street 2:SUITE B
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7518
Practice Address - Country:US
Practice Address - Phone:208-680-6488
Practice Address - Fax:208-523-8978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-272351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000580Medicare PIN