| Mental Wellness Clinic Of Coeur D Alene Inc | |
|
1105 W Ironwood Dr Coeur D Alene ID 83814-2613 | |
| (208) 676-1003 | |
| (208) 676-1009 |
| Full Name | Mental Wellness Clinic Of Coeur D Alene Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1105 W Ironwood Dr, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Kelly Lagrou (OWNER PROGRAM MANAGER) |
| Authorized Official Contact | 2086761003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mental Wellness Clinic Of Coeur D Alene Inc 500 N Government Way Suite 100 Coeur D Alene ID 83814-2913 Ph: (208) 676-1003 | Mental Wellness Clinic Of Coeur D Alene Inc 1105 W Ironwood Dr Coeur D Alene ID 83814-2613 Ph: (208) 676-1003 |
| NPI Number | 1871713925 |
|---|---|
| Provider Enumeration Date | 04/30/2007 |
| Last Update Date | 11/22/2017 |
| Medicare PECOS PAC ID | 9537434014 |
|---|---|
| Medicare Enrollment ID | O20171130001622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871713925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Wayne Timonen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093813446 PECOS PAC ID: 6103955117 Enrollment ID: I20100601000817 |
| Provider Name | Fred M Itveldt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619393204 PECOS PAC ID: 4385867282 Enrollment ID: I20160630000068 |
| Provider Name | Kathleen Samsel |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164867107 PECOS PAC ID: 7315210812 Enrollment ID: I20170905003071 |
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 | |
Idaho Dept Of Health & Welfare Reg 1 Amh Psr Cda Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2195 Ironwood Ct, Coeur D Alene, ID 83814 Phone: 208-769-1406 Fax: 208-769-1430 | |
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 |