| Child & Youth Study Center | |
|
121 West Sweet Avenue Moscow ID 83843 | |
| (208) 885-6191 | |
| (208) 885-6188 |
| Full Name | Child & Youth Study Center |
|---|---|
| Speciality | Psychologist - Clinical Child & Adolescent |
| Location | 121 West Sweet Avenue, Moscow, Idaho |
| Authorized Official Name and Position | Gwen Elaine Mitchell (DIRECTOR) |
| Authorized Official Contact | 2088856191 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Child & Youth Study Center 875 Perimeter Drive Ms 4061 Moscow ID 83844-4061 Ph: (208) 885-3588 | Child & Youth Study Center 121 West Sweet Avenue Moscow ID 83843 Ph: (208) 885-6191 |
| NPI Number | 1609902980 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 04/01/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609902980 | NPI | - | NPPES |
| 807220700 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | (* (Not Available)) | Primary |
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