| Bear Lake Memorial Hospital Mental Health | |
|
455 Washington St Ste 2 Montpelier ID 83254-1600 | |
| (208) 847-4464 | |
| (208) 847-3093 |
| Full Name | Bear Lake Memorial Hospital Mental Health |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 455 Washington St, Montpelier, Idaho |
| Authorized Official Name and Position | Shae Jayden Kunz (OFFICE MANAGER/CREDENTIALING) |
| Authorized Official Contact | 2088474464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bear Lake Memorial Hospital Mental Health 455 Washington St Ste 2 Montpelier ID 83254-1600 Ph: (208) 847-4464 | Bear Lake Memorial Hospital Mental Health 455 Washington St Ste 2 Montpelier ID 83254-1600 Ph: (208) 847-4464 |
| NPI Number | 1447452800 |
|---|---|
| Provider Enumeration Date | 06/05/2007 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447452800 | NPI | - | NPPES |
| 804083400 | Medicaid | ID | |
| 805405600 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 35 (Idaho) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
Fortify Family Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 720 Washington St, Montpelier, ID 83254 Phone: 208-220-4197 |