Provider Demographics
NPI:1952412033
Name:THE CHILDREN'S CENTER
Entity Type:Organization
Organization Name:THE CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAPO
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-233-3353
Mailing Address - Street 1:2150 STEVEN ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-1957
Mailing Address - Country:US
Mailing Address - Phone:208-757-8434
Mailing Address - Fax:
Practice Address - Street 1:1151 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2763
Practice Address - Country:US
Practice Address - Phone:208-233-3353
Practice Address - Fax:208-233-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-27085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty