IDAHO DEPT OF HEALTH & WELFARE REG 1 AHM PSR SANDPOINT - NPI 1417084716

Q: What is Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

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About Idaho Dept Of Health & Welfare Reg 1 Ahm Psr Sandpoint NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDAHO DEPT OF HEALTH & WELFARE REG 1 AHM PSR SANDPOINT (NPI 1417084716) is a healthcare organization registered as a mental health (including community mental health center) in Ponderay, Idaho and active in the NPI registry since February 2007. The organization lists Holly Bonwell, Program Manager, as its authorized official.

NPPES Registry Identity

NPI1417084716

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NameIDAHO DEPT OF HEALTH & WELFARE REG 1 AHM PSR SANDPOINT

Location Address207 LARKSPUR STPonderay, ID 83852-5011

Mailing Address207 Larkspur StPonderay, ID 83852-5011 · (208) 265-4535 · Fax (208) 263-4198

Phone(208) 265-4535

Fax(208) 263-4198

Organization SubpartNo

Authorized OfficialHolly BonwellProgram Manager · (208) 769-1406

Enumeration DateFebruary 27, 2007

Last NPPES UpdateAugust 25, 2016

✔ NPI 1417084716 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

207 LARKSPUR ST, Ponderay, ID 83852

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Other Identifiers 3

Medicaid8073518ID

OtherHW256Blue Cross Of Idaho

Other000010018348Blue Shield

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANNA LOUISE LAWRENCE LCSW

Social Worker (Clinical)