Idaho Dept of Health & Welfare Reg 1 Ahm Psr Sandpoint

NPI #1417084716 in Ponderay, Idaho

Provider Information

NPI Number
1417084716
Entity Type
Organization
Organization Name
Idaho Dept of Health & Welfare Reg 1 Ahm Psr Sandpoint
Primary Specialty
Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date
Feb 27, 2007
Last Updated
Aug 25, 2016

Practice Location

Address
207 LARKSPUR ST
State
Idaho
ZIP Code
83852-5011
Phone
(208) 265-4535

Authorized Official

Name
HOLLY BONWELL
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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