Idaho State University

NPI #1235737347 in Meridian, Idaho

Provider Information

NPI Number
1235737347
Entity Type
Organization
Organization Name
Idaho State University
Subpart
Yes (part of a larger organization)
Parent Organization
IDAHO STATE UNIVERSITY
Primary Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date
Oct 12, 2020
Last Updated
Oct 12, 2020

Practice Location

Address
1311 E CENTRAL DR
State
Idaho
ZIP Code
83642-7991
Phone
(208) 373-1719

Authorized Official

Name
CYNTHIA LEE ROCK
Title
CLINICS DIRECTOR OF OPERATIONS
Phone
(208) 373-1743

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)Mental Health (Including Community Mental Health Center)

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