| Idaho Dept Of Health & Welfare Reg 1 Amh Psr Cda | |
|
2195 Ironwood Ct Coeur D Alene ID 83814-2628 | |
| (208) 769-1406 | |
| (208) 769-1430 |
| Full Name | Idaho Dept Of Health & Welfare Reg 1 Amh Psr Cda |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2195 Ironwood Ct, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Cora Jo Gussenhoven (PROGRAM MANAGER) |
| Authorized Official Contact | 2087691406 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 1 Amh Psr Cda 2195 Ironwood Ct Coeur D Alene ID 83814-2628 Ph: (208) 769-1406 | Idaho Dept Of Health & Welfare Reg 1 Amh Psr Cda 2195 Ironwood Ct Coeur D Alene ID 83814-2628 Ph: (208) 769-1406 |
| NPI Number | 1023145893 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023145893 | NPI | - | NPPES |
| 0028407 | Medicaid | ID | |
| 000010018348 | Other | BLUE SHIELD | |
| HW256 | Other | BLUE CROSS OF IDAHO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Ambitions Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1044 Northwest Blvd Ste C, Coeur D Alene, ID 83814 Phone: 208-930-1740 Fax: 208-930-1695 | |
Restored Paths Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 109 E Harrison Ave, Coeur D Alene, ID 83814 Phone: 208-664-8347 | |
Cooksey Counseling, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 250 Northwest Blvd Ste 107a, Coeur D Alene, ID 83814 Phone: 208-551-5158 | |
North Lakes Family Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 611 E Lakeside Ave, Coeur D Alene, ID 83814 Phone: 208-664-5941 | |
Mental Wellness Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 500 N Government Way Ste 100, Coeur D Alene, ID 83814 Phone: 208-676-1003 Fax: 208-676-1009 | |
Empowered Through Play Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 560 W Canfield Ave, Ste 300, Coeur D Alene, ID 83815 Phone: 208-758-7111 |