| Organization Name: | POWDER BASIN ASSOCIATES |
| NPI Number: | 1811154883 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LYNN A MOORE (OWNER PRESIDENT) |
| Mailing Address: | 204 Oregon St Kellogg |
| State: | ID US |
| Postal Code: | 838375008 |
| Phone Number: | 2087830427 |
| Fax Number: | 2087831387 |
| NPI Enumeration Date: | 05/19/2008 |
| NPI Last Update Date: | 05/19/2008 |
| 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: | |