| Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc | |
|
421 Memorial Dr Pocatello ID 83201-4008 | |
| (208) 234-7900 | |
| (208) 236-6328 |
| Full Name | Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 421 Memorial Dr, Pocatello, Idaho |
| Authorized Official Name and Position | Ed Axford (PROGRAM MANAGER) |
| Authorized Official Contact | 2082347900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc 421 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 234-7900 | Idaho Dept Of Health & Welfare Reg 6 Amh Psr Poc 421 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 234-7900 |
| NPI Number | 1225169139 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225169139 | NPI | - | NPPES |
| HW108 | Other | ID | BLUE CROSS OF IDAHO |
| 000010019235 | Other | ID | BLUE SHIELD |
| 0028411 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Allies Family Solutions Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 850 E Lander St, Pocatello, ID 83201 Phone: 208-234-2094 Fax: 208-234-2637 | |
Lighthouse For Recovery, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1135 Yellowstone Ave, Suite D, Pocatello, ID 83201 Phone: 208-232-2908 Fax: 208-232-5423 | |
Apex Professional Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 Wilson Ave, Suite C-3, Pocatello, ID 83201 Phone: 208-904-0225 Fax: 866-704-4580 | |
Behavioral Reform Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1135 Yellowstone Ave Ste D, Pocatello, ID 83201 Phone: 208-238-9400 Fax: 208-238-9401 | |
Psychological Assessment Specialists Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1246 Yellowstone Ave Ste C5, Pocatello, ID 83201 Phone: 208-233-0150 Fax: 208-233-0159 | |
Broncho Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 772 E Ross Fork Road #41, Pocatello, ID 83202 Phone: 208-220-7520 | |
A To Z Family Services Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 Washington Ave, Pocatello, ID 83201 Phone: 208-478-9822 Fax: 208-478-6790 |