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Organization
STATE OF MIND COUNSELING AND WELLNESS CENTER
Active
Organization
STATE OF MIND COUNSELING AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA SMITH (LPC)
(208) 602-2293
Entity
Organization
Contact information
Practice address
141 N PALMETTO AVE UNIT 1626, EAGLE, ID 83616-8066
(208) 939-3999
Mailing address
233 W STATE ST STE D, EAGLE, ID 83616-4982
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
4841
ID
261QM0850X
Adult Mental Health Clinic/Center
4841
ID
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
4841
ID
Other
Enumeration date
05/22/2012
Last updated
07/27/2012
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