Idaho Dept of Health & Welfare Reg 1 Amh Psr Bonners Ferry
NPI #1376670091 in Bonners Ferry, Idaho
Provider Information
- NPI Number
- 1376670091
- Entity Type
- Organization
- Organization Name
- Idaho Dept of Health & Welfare Reg 1 Amh Psr Bonners Ferry
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Feb 28, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- RT 4 6522 TAMARACK LN
- City
- Bonners Ferry
- State
- Idaho
- ZIP Code
- 83805-9805
- Phone
- (208) 267-3187
Authorized Official
- Name
- CORA JO GUSSENHOVEN
- Title
- PROGRAM MANAGER
- Phone
- (208) 769-1406
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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