Provider Demographics
NPI:1871669903
Name:FRANCISCAN LIFE CENTER NETWORK
Entity Type:Organization
Organization Name:FRANCISCAN LIFE CENTER NETWORK
Other - Org Name:FRANCISCAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE &FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-233-9383
Mailing Address - Street 1:PO BOX 2955
Mailing Address - Street 2:1745 POCATELLO CREEK
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206
Mailing Address - Country:US
Mailing Address - Phone:208-233-9383
Mailing Address - Fax:208-233-2707
Practice Address - Street 1:1745 POCATELLO CREEK
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83206
Practice Address - Country:US
Practice Address - Phone:208-233-9383
Practice Address - Fax:208-233-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty