Provider Demographics
NPI:1912088253
Name:FRANCISCAN LIFE CENTER NETWORK, INC.
Entity Type:Organization
Organization Name:FRANCISCAN LIFE CENTER NETWORK, INC.
Other - Org Name:FRANCISACAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SISTER MARY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC AND LMFT
Authorized Official - Phone:208-233-9383
Mailing Address - Street 1:1745 POCATELLO CREEK RD
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2308
Mailing Address - Country:US
Mailing Address - Phone:208-233-9383
Mailing Address - Fax:208-233-2707
Practice Address - Street 1:1745 POCATELLO CREEK RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2308
Practice Address - Country:US
Practice Address - Phone:208-233-9383
Practice Address - Fax:208-233-2707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCISCAN LIFE CENTER NETWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPCP-204101YM0800X
IDLMFT-3003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805747600Medicaid