| A Body & Mind Health Services, Llc | |
|
148 S Cole Rd Boise ID 83709-0932 | |
| (208) 683-8320 | |
| (208) 969-8380 |
| Full Name | A Body & Mind Health Services, Llc |
|---|---|
| Speciality | Counselor |
| Location | 148 S Cole Rd, Boise, Idaho |
| Authorized Official Name and Position | Michael Cooper (CFO, PRESIDENT) |
| Authorized Official Contact | 2086838320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Body & Mind Health Services, Llc 148 S Cole Rd Boise ID 83709-0932 Ph: (208) 683-8320 | A Body & Mind Health Services, Llc 148 S Cole Rd Boise ID 83709-0932 Ph: (208) 683-8320 |
| NPI Number | 1326501305 |
|---|---|
| Provider Enumeration Date | 04/08/2019 |
| Last Update Date | 08/01/2024 |
| Certification Date | 08/01/2024 |
| Medicare PECOS PAC ID | 5193137727 |
|---|---|
| Medicare Enrollment ID | O20201223001200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326501305 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Emily Jean Bullard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265004378 PECOS PAC ID: 8224431275 Enrollment ID: I20210728001553 |
| Provider Name | Billylynn Leiuilani Pestell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497318802 PECOS PAC ID: 2466875505 Enrollment ID: I20231108002921 |
| Provider Name | Linda A Rogers-perkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528120789 PECOS PAC ID: 8325496375 Enrollment ID: I20231130003414 |
| Provider Name | Benjamin Allan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497419485 PECOS PAC ID: 9234579277 Enrollment ID: I20240424003356 |
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