Provider Demographics
NPI:1255790069
Name:JOLLIFF COUNSELING & BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:JOLLIFF COUNSELING & BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-736-0995
Mailing Address - Street 1:837 POLE LINE RD
Mailing Address - Street 2:STE 1050
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3095
Mailing Address - Country:US
Mailing Address - Phone:208-736-0995
Mailing Address - Fax:208-736-0999
Practice Address - Street 1:837 POLE LINE RD
Practice Address - Street 2:STE 1050
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3095
Practice Address - Country:US
Practice Address - Phone:208-736-0995
Practice Address - Fax:208-736-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806856500Medicaid