| Full Name | White Pine Ventures |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 63 E 1st S, Rexburg, Idaho |
| Authorized Official Name and Position | Peter Herbert Benson (CEO) |
| Authorized Official Contact | 8019990580 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| White Pine Ventures Po Box 873 Rexburg ID 83440-0873 Ph: (801) 999-0580 | White Pine Ventures 63 E 1st S Rexburg ID 83440-1938 Ph: (801) 999-0580 |
| NPI Number | 1275101776 |
|---|---|
| Provider Enumeration Date | 06/12/2021 |
| Last Update Date | 06/12/2021 |
| Certification Date | 06/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275101776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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