Basic Information
| Provider Information | |||||||||
| NPI: | 1487724407 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH IDAHO MENTAL HEALTH ASSOC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660448 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Practice Location | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086660448 | ||||||||
| FaxNumber: | 2086660468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 07/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2085561802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.