| Lone Pine Behavioral Health Llc | |
|
1030 S 3rd St St Maries ID 83861-1958 | |
| (208) 274-3430 | |
| Not Available |
| Full Name | Lone Pine Behavioral Health Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1030 S 3rd St, St Maries, Idaho |
| Authorized Official Name and Position | Seth Patzer (OWNER/THERAPIST) |
| Authorized Official Contact | 2082743430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lone Pine Behavioral Health Llc Po Box 191 St Maries ID 83861-0191 Ph: (208) 274-3430 | Lone Pine Behavioral Health Llc 1030 S 3rd St St Maries ID 83861-1958 Ph: (208) 274-3430 |
| NPI Number | 1386343952 |
|---|---|
| Provider Enumeration Date | 03/02/2023 |
| Last Update Date | 03/02/2023 |
| Certification Date | 03/02/2023 |
| Medicare PECOS PAC ID | 8022473750 |
|---|---|
| Medicare Enrollment ID | O20230502000338 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386343952 | NPI | - | NPPES |
| 1770950016 | Other | ID | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Seth Patzer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770950016 PECOS PAC ID: 4587990155 Enrollment ID: I20190719002988 |
Idaho Dept Of Health & Welfare Reg 1 Amh Psr St Maries Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 S 7th St, St Maries, ID 83861 Phone: 208-245-2541 Fax: 208-245-7131 | |
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 | |
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