| Elevated Mental Wellness | |
|
15149 W Lacey Rd Pocatello ID 83202-5044 | |
| (208) 254-0133 | |
| Not Available |
| Full Name | Elevated Mental Wellness |
|---|---|
| Speciality | Counselor |
| Location | 15149 W Lacey Rd, Pocatello, Idaho |
| Authorized Official Name and Position | Brett M. Judd (OWNER) |
| Authorized Official Contact | 2082540133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elevated Mental Wellness 1110 Yellowstone Ave # 178 Pocatello ID 83201-4312 Ph: (208) 254-0133 | Elevated Mental Wellness 15149 W Lacey Rd Pocatello ID 83202-5044 Ph: (208) 254-0133 |
| NPI Number | 1447811948 |
|---|---|
| Provider Enumeration Date | 06/25/2019 |
| Last Update Date | 02/07/2024 |
| Certification Date | 02/07/2024 |
| Medicare PECOS PAC ID | 8820411507 |
|---|---|
| Medicare Enrollment ID | O20200714001725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447811948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Brett M Judd |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821113895 PECOS PAC ID: 2860815081 Enrollment ID: I20200820001566 |
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