Basic Information
| Provider Information | |||||||||
| NPI: | 1598766347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HOPE CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 BANK ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALLACE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838732225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085560960 | ||||||||
| FaxNumber: | 2085560970 | ||||||||
| Practice Location | |||||||||
| Address1: | 518 BANK ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WALLACE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838732225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085560960 | ||||||||
| FaxNumber: | 2085560970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ARFORD | ||||||||
| AuthorizedOfficialFirstName: | ERROL | ||||||||
| AuthorizedOfficialMiddleName: | HERMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 2085560960 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 000010144544 | 01 | ID | REGENCE | OTHER |