Idaho Dept of Health & Welfare Reg 1 Amh Clinic Cda
NPI #1831226547 in Coeur D Alene, Idaho
Provider Information
- NPI Number
- 1831226547
- Entity Type
- Organization
- Organization Name
- Idaho Dept of Health & Welfare Reg 1 Amh Clinic Cda
- Primary Specialty
- Clinic/Center - Adult Mental Health
- Enumeration Date
- Feb 28, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 2195 IRONWOOD CT
- City
- Coeur D Alene
- State
- Idaho
- ZIP Code
- 83814-2628
- Phone
- (208) 769-1406
Authorized Official
- Name
- CORA JO GUSSENHOVEN
- Title
- PROGRAM MANAGER
- Phone
- (208) 769-1406
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Adult Mental Health — Adult Mental Health |
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