| Portneuf Valley Family Center | |
|
444 Hospital Way Ste 477 Pocatello ID 83201-2744 | |
| (208) 233-7832 | |
| (208) 233-7835 |
| Full Name | Portneuf Valley Family Center |
|---|---|
| Speciality | Counselor |
| Location | 444 Hospital Way Ste 477, Pocatello, Idaho |
| Authorized Official Name and Position | Robert Andrew De Wall (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 2082337832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Portneuf Valley Family Center Po Box 4908 Pocatello ID 83205-4908 Ph: (208) 236-1600 | Portneuf Valley Family Center 444 Hospital Way Ste 477 Pocatello ID 83201-2744 Ph: (208) 233-7832 |
| NPI Number | 1174629976 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 10/22/2021 |
| Certification Date | 10/22/2021 |
| Medicare PECOS PAC ID | 6901807718 |
|---|---|
| Medicare Enrollment ID | O20070122000564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174629976 | NPI | - | NPPES |
| 807338300 | Medicaid | ID | |
| 807319500 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| Provider Name | Kelly Palmer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184780694 PECOS PAC ID: 5991879892 Enrollment ID: I20080809000124 |
| Provider Name | Brooke J Golightly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528304722 PECOS PAC ID: 4385884576 Enrollment ID: I20130711000581 |
| Provider Name | Brian Brimhall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245796101 PECOS PAC ID: 6103168745 Enrollment ID: I20190430002048 |
| Provider Name | Kelly A Lind |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184176463 PECOS PAC ID: 9739414277 Enrollment ID: I20190705000625 |
| Provider Name | Paul Cody Jameson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982271904 PECOS PAC ID: 8820492903 Enrollment ID: I20210811003026 |
| Provider Name | Elizabeth Macklin |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588219497 PECOS PAC ID: 5890157861 Enrollment ID: I20231127001839 |
| Provider Name | Charity Potter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952420077 PECOS PAC ID: 2668712704 Enrollment ID: I20240102002429 |
| Provider Name | Robert De Wall |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114228384 PECOS PAC ID: 3577803618 Enrollment ID: I20240105001480 |
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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 | |
A To Z Family Services Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 Washington Ave, Pocatello, ID 83201 Phone: 208-478-9822 Fax: 208-478-6790 |