Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries
Clinic/Center, Mental Health (Including Community Mental Health Center) in St Maries, ID. Organization (NPI-2).
NPI number1144357369
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1144357369
- Entity type
- Organization (NPI-2)
- Legal business name
- Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries
- Organization subpart
- No
- Enumeration date
- Feb 27, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | Yes |
Practice location
222 S 7th StSt Maries, ID 83861-1847
Phone 208-245-2541 · Fax 208-245-7131
Mailing address
Po Box 248St Maries, ID 83861-0248
Phone 208-245-2541 · Fax 208-245-7131
Authorized official
Cora Jo Gussenhoven
Program Manager
2087691406
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