| Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint | |
|
207 Larkspur St Ponderay ID 83852-5011 | |
| (208) 265-4535 | |
| (208) 263-4198 |
| Full Name | Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 207 Larkspur St, Ponderay, Idaho |
| Authorized Official Name and Position | Holly Bonwell (PROGRAM MANAGER) |
| Authorized Official Contact | 2087691406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint 207 Larkspur St Ponderay ID 83852-5011 Ph: (208) 265-4535 | Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint 207 Larkspur St Ponderay ID 83852-5011 Ph: (208) 265-4535 |
| NPI Number | 1417084716 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/25/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417084716 | NPI | - | NPPES |
| 8073518 | Medicaid | ID | |
| HW256 | Other | BLUE CROSS OF IDAHO | |
| 000010018348 | Other | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Idaho Dept Of Health & Welfare Reg 1 Amh Clinic Sandpoint Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 Larkspur St, Ponderay, ID 83852 Phone: 208-265-4535 Fax: 208-263-4198 | |
7b Psychotherapy, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 30544 Highway 200 Bldg 300, Ponderay, ID 83852 Phone: 208-946-7333 Fax: 208-625-2066 |