Idaho Dept of Health & Welfare Reg 1 Amh Psr St Maries

NPI #1144357369 in St Maries, Idaho

Provider Information

NPI Number: 1144357369
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 1 Amh Psr St Maries
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Feb 27, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 222 S 7TH ST
City: St Maries
State: Idaho
ZIP Code: 83861-1847
Phone: (208) 245-2541

Authorized Official

Name: CORA JO GUSSENHOVEN
Title: PROGRAM MANAGER
Phone: (208) 769-1406

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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