| Canvi Behavioral Health Pllc | |
|
4650 Hawthorne Rd Ste 3b Chubbuck ID 83202-2376 | |
| (208) 252-5621 | |
| (208) 648-4167 |
| Full Name | Canvi Behavioral Health Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4650 Hawthorne Rd Ste 3b, Chubbuck, Idaho |
| Authorized Official Name and Position | Krista Batts (CONTRACTING MANAGER) |
| Authorized Official Contact | 2083804978 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canvi Behavioral Health Pllc Po Box 2516 Pocatello ID 83206-2516 Ph: (208) 380-4978 | Canvi Behavioral Health Pllc 4650 Hawthorne Rd Ste 3b Chubbuck ID 83202-2376 Ph: (208) 252-5621 |
| NPI Number | 1144984873 |
|---|---|
| Provider Enumeration Date | 10/28/2021 |
| Last Update Date | 04/12/2024 |
| Certification Date | 04/12/2024 |
| Medicare PECOS PAC ID | 0941692073 |
|---|---|
| Medicare Enrollment ID | O20220121000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144984873 | NPI | - | NPPES |
| Provider Name | Kelly Palmer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184780694 PECOS PAC ID: 5991879892 Enrollment ID: I20080809000124 |
| Provider Name | Hyrum Davenport |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255567210 PECOS PAC ID: 4789736083 Enrollment ID: I20090717000227 |
| Provider Name | Jennie L Brumfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811369689 PECOS PAC ID: 7214238963 Enrollment ID: I20151222001567 |
| Provider Name | Amy Lynne Belnap |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699202044 PECOS PAC ID: 6406120765 Enrollment ID: I20170926000321 |
| Provider Name | Kay Martens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538708862 PECOS PAC ID: 1254735954 Enrollment ID: I20210803000843 |
| Provider Name | Carol Anne Eddy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265683593 PECOS PAC ID: 7315340197 Enrollment ID: I20220616000703 |
| Provider Name | Heidi Rasmussen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982253506 PECOS PAC ID: 8921495920 Enrollment ID: I20221017002153 |
| Provider Name | Natalie Chase Christensen |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1952812067 PECOS PAC ID: 8426410762 Enrollment ID: I20230817002380 |
| Provider Name | Tara Arocho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649952953 PECOS PAC ID: 9830543354 Enrollment ID: I20231002001924 |
| Provider Name | Matt Kam |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1457646895 PECOS PAC ID: 6406178268 Enrollment ID: I20240112001244 |
| Provider Name | Matthew Dunham |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1700159852 PECOS PAC ID: 8224480140 Enrollment ID: I20240520003280 |
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