Idaho Dept of Health & Welfare Reg II Amh Lewiston

NPI #1073641262 in Lewiston, Idaho

Provider Information

NPI Number: 1073641262
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg II Amh Lewiston
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Mar 1, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 1118 F ST
City: Lewiston
State: Idaho
ZIP Code: 83501-1930
Phone: (208) 799-4440

Authorized Official

Name: VICKI R. MALONE, MSW
Title: PROGRAM MANAGER
Phone: (208) 799-4440

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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