Organization Name: | SEASONS OF HOPE |
NPI Number: | 1255645610 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEATH JACOB SOMMER (CEO) |
Mailing Address: | 4650 Hawthorne Rd Chubbuck |
State: | ID US |
Postal Code: | 832022376 |
Phone Number: | 2082379833 |
Fax Number: | 2082371800 |
NPI Enumeration Date: | 07/28/2010 |
NPI Last Update Date: | 07/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY202423 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |