| Psychological Preventative Health Pllc | |
|
2300 N Yellowstone Hwy Ste 207 Idaho Falls ID 83401-1652 | |
| (801) 719-7737 | |
| (888) 887-9784 |
| Full Name | Psychological Preventative Health Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 N Yellowstone Hwy Ste 207, Idaho Falls, Idaho |
| Authorized Official Name and Position | Melanie Richarson (OWNER) |
| Authorized Official Contact | 8017197737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Preventative Health Pllc 2184 Channing Way # 157 Idaho Falls ID 83404-8034 Ph: (208) 709-3925 | Psychological Preventative Health Pllc 2300 N Yellowstone Hwy Ste 207 Idaho Falls ID 83401-1652 Ph: (801) 719-7737 |
| NPI Number | 1649808767 |
|---|---|
| Provider Enumeration Date | 04/01/2020 |
| Last Update Date | 02/21/2022 |
| Certification Date | 02/08/2022 |
| Medicare PECOS PAC ID | 8820414600 |
|---|---|
| Medicare Enrollment ID | O20200812000356 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649808767 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Ka-sia M Baumer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568647998 PECOS PAC ID: 3173837515 Enrollment ID: I20150729010456 |
| Provider Name | Melanie Richardson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013328103 PECOS PAC ID: 2961777438 Enrollment ID: I20171010000104 |
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