| Idaho Dept Of Health & Welfare Reg 6 Cmh Poc Clinic | |
|
421 Memorial Dr Pocatello ID 83201-4008 | |
| (208) 234-7900 | |
| (208) 236-6328 |
| Full Name | Idaho Dept Of Health & Welfare Reg 6 Cmh Poc Clinic |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 421 Memorial Dr, Pocatello, Idaho |
| Authorized Official Name and Position | Ritchie Weers (CLINICAL SUPERVISOR) |
| 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 Cmh Poc Clinic 421 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 234-7900 | Idaho Dept Of Health & Welfare Reg 6 Cmh Poc Clinic 421 Memorial Dr Pocatello ID 83201-4008 Ph: (208) 234-7900 |
| NPI Number | 1780715045 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 10/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780715045 | NPI | - | NPPES |
| HW157 | Other | ID | BLUE CROSS OF IDAHO |
| 8073651 | Medicaid | ID | |
| 000010019402 | Other | ID | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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Psychological Assessment Specialists Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1246 Yellowstone Ave Ste C5, Pocatello, ID 83201 Phone: 208-233-0150 Fax: 208-233-0159 | |
Broncho Mental Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 772 E Ross Fork Road #41, Pocatello, ID 83202 Phone: 208-220-7520 | |
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