| Regenerize Psychiatry Pllc | |
|
605 S Olive Ave Sandpoint ID 83864-1154 | |
| (209) 677-7747 | |
| Not Available |
| Full Name | Regenerize Psychiatry Pllc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 605 S Olive Ave, Sandpoint, Idaho |
| Authorized Official Name and Position | Radley Peterson (OWNER) |
| Authorized Official Contact | 2088995997 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Regenerize Psychiatry Pllc 605 S Olive Ave Sandpoint ID 83864-1154 Ph: (208) 606-0620 | Regenerize Psychiatry Pllc 605 S Olive Ave Sandpoint ID 83864-1154 Ph: (209) 677-7747 |
| NPI Number | 1043054075 |
|---|---|
| Provider Enumeration Date | 06/24/2024 |
| Last Update Date | 10/27/2024 |
| Certification Date | 10/27/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043054075 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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