Blackfoot Medical Clinic Mental Health
Counselor, Professional in Blackfoot, ID. Organization (NPI-2).
NPI number1265635205
StatusActive
Last updated in NPPESAug 22, 2020
Details
- NPI
- 1265635205
- Entity type
- Organization (NPI-2)
- Legal business name
- Blackfoot Medical Clinic Mental Health
- Organization subpart
- No
- Enumeration date
- Jun 7, 2007
- Last updated
- Aug 22, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | – | – | Yes |
Practice location
1441 Parkway DrBlackfoot, ID 83221-1667
Phone 208-785-2600
Mailing address
1441 Parkway DrBlackfoot, ID 83221-1667
Phone 208-785-2600
Authorized official
Betty Miller
Business Office Manager
2087852600
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