Basic Information
| Provider Information | |||||||||
| NPI: | 1154783538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTHWEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832015757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082326260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 N 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832015757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082326260 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MURPHY | ||||||||
| AuthorizedOfficialFirstName: | AMELIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2082327862 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | SE-202913 | ID | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.