| Idaho Dept Of Health & Welfare Reg 6 Amh Psr Pres | |
|
223 N State St Preston ID 83263-1140 | |
| (208) 852-0634 | |
| (208) 852-2136 |
| Full Name | Idaho Dept Of Health & Welfare Reg 6 Amh Psr Pres |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 223 N State St, Preston, Idaho |
| Authorized Official Name and Position | Ed Axford (PROGRAM MANAGER) |
| Authorized Official Contact | 2082347900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dept Of Health & Welfare Reg 6 Amh Psr Pres 421 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 234-7900 | Idaho Dept Of Health & Welfare Reg 6 Amh Psr Pres 223 N State St Preston ID 83263-1140 Ph: (208) 852-0634 |
| NPI Number | 1275664583 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275664583 | NPI | - | NPPES |
| HW108 | Other | ID | BLUE CROSS OF IDAHO |
| 000010019235 | Other | ID | BLUE SHIELD |
| 8073684 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Priestley Mental Health Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 75 S 1st W, Preston, ID 83263 Phone: 208-852-2370 Fax: 208-852-5570 | |
Preston Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 15 E Oneida St, Preston, ID 83263 Phone: 208-852-2407 Fax: 877-650-7823 | |
Summit Counseling Services Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 655 S 4th E Ste 104, Preston, ID 83263 Phone: 435-994-0508 |