Basic Information
| Provider Information | |||||||||
| NPI: | 1588942304 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HIGHER CONNECTION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3482 | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838773482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086423396 | ||||||||
| FaxNumber: | 2086429060 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | PAYETTE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836612535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086423396 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2011 | ||||||||
| LastUpdateDate: | 10/19/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARROLL | ||||||||
| AuthorizedOfficialFirstName: | BEATRICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2086423396 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW-1159 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.