| Ellie Mental Health | |
|
3676 N Harbor Ln Boise ID 83703-6918 | |
| (208) 761-0533 | |
| Not Available |
| Full Name | Ellie Mental Health |
|---|---|
| Speciality | Counselor |
| Location | 3676 N Harbor Ln, Boise, Idaho |
| Authorized Official Name and Position | Randi Mcdermott (OWNER) |
| Authorized Official Contact | 2087610533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health 2939 N Lancaster Dr Boise ID 83702-0644 Ph: () - | Ellie Mental Health 3676 N Harbor Ln Boise ID 83703-6918 Ph: (208) 761-0533 |
| NPI Number | 1932844131 |
|---|---|
| Provider Enumeration Date | 05/02/2022 |
| Last Update Date | 05/10/2022 |
| Certification Date | 05/10/2022 |
| Medicare PECOS PAC ID | 4688018435 |
|---|---|
| Medicare Enrollment ID | O20240220002383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932844131 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dynisha Smith |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679172472 PECOS PAC ID: 7113361965 Enrollment ID: I20240327001525 |
| Provider Name | Raymond Dyer |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871060012 PECOS PAC ID: 7214376573 Enrollment ID: I20240418003962 |
| Provider Name | Yves R Pogue |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457012130 PECOS PAC ID: 3476994047 Enrollment ID: I20240514001228 |
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