| Latino Stand Up | |
|
1420 E 17th St Ste E Idaho Falls ID 83404-6283 | |
| (208) 528-5434 | |
| (208) 522-4364 |
| Full Name | Latino Stand Up |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1420 E 17th St Ste E, Idaho Falls, Idaho |
| Authorized Official Name and Position | Roger T Horne (OWNER) |
| Authorized Official Contact | 9105730861 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Latino Stand Up 1420 E 17th St Ste E Idaho Falls ID 83404-6283 Ph: (208) 528-5434 | Latino Stand Up 1420 E 17th St Ste E Idaho Falls ID 83404-6283 Ph: (208) 528-5434 |
| NPI Number | 1164781365 |
|---|---|
| Provider Enumeration Date | 05/08/2012 |
| Last Update Date | 03/31/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164781365 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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