Organization Name: | SEQUEL ALLIANCE FAMILY SERVICES, LLC |
NPI Number: | 1215359856 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY CAUDLE (CBO DIRECTOR OF PATIENT ACCOUNTS) |
Mailing Address: | 89 Homer Dr St Maries |
State: | ID US |
Postal Code: | 838615078 |
Phone Number: | 2082455427 |
Fax Number: | 2082455427 |
NPI Enumeration Date: | 01/16/2014 |
NPI Last Update Date: | 01/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |