Provider Demographics
NPI:1891900064
Name:LDS FAMILY SERVICES
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES
Other - Org Name:LDS FAMILY SERVICES ID BOISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:THROCKMORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-376-0191
Mailing Address - Street 1:10740 W FAIRVIEW AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-7926
Mailing Address - Country:US
Mailing Address - Phone:208-376-0191
Mailing Address - Fax:208-658-6299
Practice Address - Street 1:10740 W FAIRVIEW AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-7926
Practice Address - Country:US
Practice Address - Phone:208-376-0191
Practice Address - Fax:208-658-6299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty