Provider Demographics
NPI:1356569495
Name:ALLSTAR COUNSELING SERVICES
Entity type:Organization
Organization Name:ALLSTAR COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUIS
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-200-7377
Mailing Address - Street 1:550 2ND ST # 292
Mailing Address - Street 2:PO BOX 1876
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3900
Mailing Address - Country:US
Mailing Address - Phone:208-200-7377
Mailing Address - Fax:208-529-4647
Practice Address - Street 1:550 2ND ST # 292
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3900
Practice Address - Country:US
Practice Address - Phone:208-200-7377
Practice Address - Fax:208-529-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-24674251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management