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1010 W Hays St Boise ID 83702-5435 | |
| (208) 284-5273 | |
| (208) 344-1982 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1010 W Hays St, Boise, Idaho |
| Authorized Official Name and Position | Mariella L. Hogan (LICENSED PSYCHOLOGIST, OWNER, MGT) |
| Authorized Official Contact | 2082845273 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1010 W Hays St Boise ID 83702-5435 Ph: (208) 284-5273 | 1010 W Hays St Boise ID 83702-5435 Ph: (208) 284-5273 |
| NPI Number | 1699075838 |
|---|---|
| Provider Enumeration Date | 10/21/2010 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699075838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | PSY-202270 (Idaho) | Primary |
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