| Mental Health Clinic Of Idaho Pllc | |
|
6737 E Deer Ridge St Boise ID 83716-7147 | |
| (979) 332-4184 | |
| Not Available |
| Full Name | Mental Health Clinic Of Idaho Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6737 E Deer Ridge St, Boise, Idaho |
| Authorized Official Name and Position | Sami Phuyal (PROVIDER/OWNER) |
| Authorized Official Contact | 9793324184 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Clinic Of Idaho Pllc 6737 E Deer Ridge St Boise ID 83716-7147 Ph: (979) 332-4184 | Mental Health Clinic Of Idaho Pllc 6737 E Deer Ridge St Boise ID 83716-7147 Ph: (979) 332-4184 |
| NPI Number | 1215622048 |
|---|---|
| Provider Enumeration Date | 04/07/2023 |
| Last Update Date | 04/18/2023 |
| Certification Date | 04/18/2023 |
| Medicare PECOS PAC ID | 0749649945 |
|---|---|
| Medicare Enrollment ID | O20230706002231 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215622048 | NPI | - | NPPES |
| 1760157598 | Other | ID | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Sami Phuyal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760157598 PECOS PAC ID: 8921494485 Enrollment ID: I20220408001625 |
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