| Idaho Dept Of Health & Welfare Reg 2 Cmh | |
|
1350 Troy Highway Moscow ID 83843-3995 | |
| (208) 882-0562 | |
| Not Available |
| Full Name | Idaho Dept Of Health & Welfare Reg 2 Cmh |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1350 Troy Highway, Moscow, Idaho |
| Authorized Official Name and Position | Vicki Malone (PROGRAM MANAGER) |
| Authorized Official Contact | 2087994440 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 2 Cmh 1350 Troy Highway Moscow ID 83843-3995 Ph: (208) 882-0562 | Idaho Dept Of Health & Welfare Reg 2 Cmh 1350 Troy Highway Moscow ID 83843-3995 Ph: (208) 882-0562 |
| NPI Number | 1639476294 |
|---|---|
| Provider Enumeration Date | 02/17/2011 |
| Last Update Date | 02/17/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639476294 | NPI | - | NPPES |
| 000010018450 | Other | ID | BLUE SHIELD |
| HW140 | Other | ID | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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