| Idaho Dept Of Health & Welfare Reg 1 Amh Psr Kellogg | |
|
35 Wildcat Way Ste B Kellogg ID 83837-2261 | |
| (208) 784-1351 | |
| (208) 784-1356 |
| Full Name | Idaho Dept Of Health & Welfare Reg 1 Amh Psr Kellogg |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 35 Wildcat Way Ste B, Kellogg, 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 Kellogg 35 Wildcat Way Ste B Kellogg ID 83837-2261 Ph: (208) 784-1351 | Idaho Dept Of Health & Welfare Reg 1 Amh Psr Kellogg 35 Wildcat Way Ste B Kellogg ID 83837-2261 Ph: (208) 784-1351 |
| NPI Number | 1730216961 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730216961 | NPI | - | NPPES |
| HW256 | Other | BLUE CROSS OF IDAHO | |
| 8073520 | Medicaid | ID | |
| 000010018348 | Other | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Powder Basin Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 Oregon St, Kellogg, ID 83837 Phone: 208-783-0427 Fax: 208-783-1387 | |
Alliance Family Services North, Inc, Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14 Emerson Ln, Kellogg, ID 83837 Phone: 208-783-0660 | |
Idaho Dept Of Health & Welfare Reg 1 Amh Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 35 Wildcat Way, Kellogg, ID 83837 Phone: 208-784-1351 Fax: 208-784-1356 | |
Heritage Mountain Health Kellogg Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 740 Mckinley Ave, Kellogg, ID 83837 Phone: 087-831-2672 Fax: 844-807-3782 | |
A New Hope Social Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 740 Mckinley Ave, Kellogg, ID 83837 Phone: 208-783-0600 Fax: 208-783-0192 | |
Sequel Alliance Family Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 14 Emerson Ln, Kellogg, ID 83837 Phone: 208-783-0660 Fax: 208-783-7542 | |
Powder Basin Associates Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 Oregon St, Kellogg, ID 83837 Phone: 208-783-0427 Fax: 208-783-1387 |