| Azure Stone Mental Health & Wellness Llc | |
|
2000 S Eagle Rd Meridian ID 83642-6707 | |
| (208) 623-8099 | |
| Not Available |
| Full Name | Azure Stone Mental Health & Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2000 S Eagle Rd, Meridian, Idaho |
| Authorized Official Name and Position | Daniel Springer (OWNER) |
| Authorized Official Contact | 2086238099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azure Stone Mental Health & Wellness Llc 2440 Legacy Dr Pocatello ID 83201-7916 Ph: (208) 623-8099 | Azure Stone Mental Health & Wellness Llc 2000 S Eagle Rd Meridian ID 83642-6707 Ph: (208) 623-8099 |
| NPI Number | 1922879394 |
|---|---|
| Provider Enumeration Date | 01/12/2024 |
| Last Update Date | 01/28/2025 |
| Certification Date | 01/28/2025 |
| Medicare PECOS PAC ID | 5991242059 |
|---|---|
| Medicare Enrollment ID | O20240807000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922879394 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Saheed Shittu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952644593 PECOS PAC ID: 7012456973 Enrollment ID: I20240823001821 |
| Provider Name | Jessica Gorringe |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912459587 PECOS PAC ID: 1658810908 Enrollment ID: I20240829004128 |
| Provider Name | John Walters |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932488426 PECOS PAC ID: 0143493049 Enrollment ID: I20241023003591 |
| Provider Name | Mathew J Gossard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710713441 PECOS PAC ID: 0446785851 Enrollment ID: I20241121004341 |
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