| Open Space Mental Health Llc | |
|
530 S Holmes Ave Idaho Falls ID 83401-5056 | |
| (307) 690-2938 | |
| Not Available |
| Full Name | Open Space Mental Health Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 530 S Holmes Ave, Idaho Falls, Idaho |
| Authorized Official Name and Position | Benjamin G Rae (OWNER) |
| Authorized Official Contact | 3076902938 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Open Space Mental Health Llc Po Box 955 Wilson WY 83014-0955 Ph: (307) 690-2938 | Open Space Mental Health Llc 530 S Holmes Ave Idaho Falls ID 83401-5056 Ph: (307) 690-2938 |
| NPI Number | 1235947524 |
|---|---|
| Provider Enumeration Date | 12/19/2024 |
| Last Update Date | 12/19/2024 |
| Certification Date | 12/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235947524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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