| Panhandle Horizons | |
|
212 S 11th St Suite 5 Coeur D Alene ID 83814-4000 | |
| (208) 755-6121 | |
| (208) 667-2681 |
| Full Name | Panhandle Horizons |
|---|---|
| Speciality | Psychologist - Rehabilitation |
| Location | 212 S 11th St, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Jack Elmo Wright (OWNER) |
| Authorized Official Contact | 4067450148 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Panhandle Horizons 32126 Allison Rd St Ignatius MT 59865-9155 Ph: (406) 745-0148 | Panhandle Horizons 212 S 11th St Suite 5 Coeur D Alene ID 83814-4000 Ph: (208) 755-6121 |
| NPI Number | 1851423446 |
|---|---|
| Provider Enumeration Date | 03/10/2007 |
| Last Update Date | 08/07/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851423446 | NPI | - | NPPES |
| 806144500 | Medicaid | ID | |
| PSY90 | Other | ID | PSYCHOLOGY LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TR0400X | Psychologist - Rehabilitation | (* (Not Available)) | Primary |
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