Idaho Dept of Health & Welfare Reg 1 Amh Psr Kellogg

NPI #1730216961 in Kellogg, Idaho

Provider Information

NPI Number: 1730216961
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 1 Amh Psr Kellogg
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Feb 27, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 35 WILDCAT WAY STE B
City: Kellogg
State: Idaho
ZIP Code: 83837-2261
Phone: (208) 784-1351

Authorized Official

Name: CORA JO GUSSENHOVEN
Title: PROGRAM MANAGER
Phone: (208) 769-1406

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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