Provider Demographics
NPI:1902031727
Name:LDS FAMILY SERVICES IDAHO BOISE AGENCY
Entity Type:Organization
Organization Name:LDS FAMILY SERVICES IDAHO BOISE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELING INTERN
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-376-0919
Mailing Address - Street 1:10740 W FAIRVIEW AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8050
Mailing Address - Country:US
Mailing Address - Phone:208-376-0919
Mailing Address - Fax:208-658-8050
Practice Address - Street 1:10740 W FAIRVIEW AVE STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8050
Practice Address - Country:US
Practice Address - Phone:208-376-0919
Practice Address - Fax:208-658-8050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LDS FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management