| Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries | |
|
222 S 7th St St Maries ID 83861-1847 | |
| (208) 245-2541 | |
| (208) 245-7131 |
| Full Name | Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 222 S 7th St, St Maries, Idaho |
| Authorized Official Name and Position | Cora Jo Gussenhoven (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 Amh Psr St Maries Po Box 248 St Maries ID 83861-0248 Ph: (208) 245-2541 | Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries 222 S 7th St St Maries ID 83861-1847 Ph: (208) 245-2541 |
| NPI Number | 1144357369 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144357369 | NPI | - | NPPES |
| 000010018348 | Other | BLUE SHIELD | |
| HW256 | Other | BLUE CROSS OF IDAHO | |
| 8073519 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Vista Outreach - Psr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 S 7th St, St Maries, ID 83861 Phone: 208-245-1920 Fax: 208-245-9206 | |
Sequel Alliance Family Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 89 Homer Dr, St Maries, ID 83861 Phone: 208-245-5427 Fax: 208-245-5427 | |
Vista Outreach - Mental Health Clinic Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 127 S 7th St, St Maries, ID 83861 Phone: 208-245-1920 Fax: 208-245-9206 | |
Lone Pine Behavioral Health Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1030 S 3rd St, St Maries, ID 83861 Phone: 208-274-3430 | |
Alliance Family Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 89 Homer Dr, St Maries, ID 83861 Phone: 208-245-5427 | |
Heritage Health Restored Paths Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 120 S 13th St, St Maries, ID 83861 Phone: 208-245-4363 Fax: 208-245-4349 |