Idaho Dept of Health & Welfare Reg 6 Amh Psr Poc

NPI #1225169139 in Pocatello, Idaho

Provider Information

NPI Number: 1225169139
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 6 Amh Psr Poc
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Mar 9, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 421 MEMORIAL DR
City: Pocatello
State: Idaho
ZIP Code: 83201-4008
Phone: (208) 234-7900

Authorized Official

Name: MR. ED AXFORD
Title: PROGRAM MANAGER
Phone: (208) 234-7900

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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