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22480 Duff Ln Middleton ID 83644-6041 | |
| (208) 965-4502 | |
| (208) 505-4280 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 22480 Duff Ln, Middleton, Idaho |
| Authorized Official Name and Position | Tanya Kristen Nelson (OWNER) |
| Authorized Official Contact | 2088002758 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
22480 Duff Ln Middleton ID 83644-6041 Ph: (208) 965-4502 | 22480 Duff Ln Middleton ID 83644-6041 Ph: (208) 965-4502 |
| NPI Number | 1457867962 |
|---|---|
| Provider Enumeration Date | 12/19/2017 |
| Last Update Date | 03/29/2024 |
| Certification Date | 03/29/2024 |
| Medicare PECOS PAC ID | 0941640668 |
|---|---|
| Medicare Enrollment ID | O20240429002295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457867962 | NPI | - | NPPES |
| 1457867962 | Medicaid | ID |
| Provider Name | Kim Alexander Nelson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1275085433 PECOS PAC ID: 4587004205 Enrollment ID: I20240603001757 |
Rachael Hall, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 8310 Purple Sage Rd, Middleton, ID 83644 Phone: 208-830-7781 |