| Delterra | |
|
172 Charles Pl Rexburg ID 83440-5452 | |
| (385) 437-0188 | |
| (855) 710-7572 |
| Full Name | Delterra |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 172 Charles Pl, Rexburg, Idaho |
| Authorized Official Name and Position | Dalynn N Moore (OWNER/CLINICIAN) |
| Authorized Official Contact | 3854370188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Delterra 172 Charles Pl Rexburg ID 83440-5452 Ph: (208) 557-1544 | Delterra 172 Charles Pl Rexburg ID 83440-5452 Ph: (385) 437-0188 |
| NPI Number | 1366188294 |
|---|---|
| Provider Enumeration Date | 05/12/2022 |
| Last Update Date | 05/12/2022 |
| Certification Date | 05/12/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366188294 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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