Idaho Dept of Health & Welfare Reg 1 Amh Clinic Sandpoint

NPI #1467589184 in Ponderay, Idaho

Provider Information

NPI Number: 1467589184
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 1 Amh Clinic Sandpoint
Primary Specialty: Clinic/Center - Adult Mental Health
Enumeration Date: Feb 28, 2007
Last Updated: Aug 25, 2016

Practice Location

Address: 207 LARKSPUR ST
City: Ponderay
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	Taxonomy Code	Primary
Clinic/Center - Adult Mental Health — Adult Mental Health	261QM0850X	Primary

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