| Mental Health Jiu Jitsu | |
|
105 Pine St Ste 105a Sandpoint ID 83864-1369 | |
| (208) 627-9930 | |
| Not Available |
| Full Name | Mental Health Jiu Jitsu |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 105 Pine St Ste 105a, Sandpoint, Idaho |
| Authorized Official Name and Position | Dante Sandro Rumore (OWNER/PROVIDER) |
| Authorized Official Contact | 2086279930 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Health Jiu Jitsu 105 Pine St Ste 105a Sandpoint ID 83864-1369 Ph: (208) 627-9930 | Mental Health Jiu Jitsu 105 Pine St Ste 105a Sandpoint ID 83864-1369 Ph: (208) 627-9930 |
| NPI Number | 1215639182 |
|---|---|
| Provider Enumeration Date | 03/21/2023 |
| Last Update Date | 07/27/2023 |
| Certification Date | 07/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215639182 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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