Latino Stand Up
NPI #1164781365 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1164781365
- Entity Type
- Organization
- Organization Name
- Latino Stand Up
- Primary Specialty
- Clinic/Center - Adolescent and Children Mental Health
- Enumeration Date
- May 8, 2012
- Last Updated
- Mar 31, 2013
Practice Location
- Address
- 1420 E 17TH ST STE E
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-6283
- Phone
- (208) 528-5434
Authorized Official
- Name
- MR. ROGER T HORNE
- Title
- OWNER
- Phone
- (910) 573-0861
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Adult Mental Health — Adult Mental Health |
| Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health |
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