Idaho Dept of Health & Welfare Reg 7 Amh Bf

NPI #1114058179 in Blackfoot, Idaho

Provider Information

NPI Number: 1114058179
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 7 Amh Bf
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Mar 8, 2007
Last Updated: Aug 10, 2010

Practice Location

Address: 720 E ALICE
City: Blackfoot
State: Idaho
ZIP Code: 83221-0129
Phone: (208) 785-5871

Authorized Official

Name: RANDY RODRIQUEZ II, LCSW
Title: PROGRAM MANAGER
Phone: (208) 528-5700

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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