# A2C CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104419423
- **Authorized official:** STACY HUMPHERYS (PRACTICE MANAGER)
- **Authorized official phone:** (208) 252-5621

## Contact information

- **Practice address:** 333 W CEDAR ST STE 3, POCATELLO, ID 83201-5045
- **Practice address phone:** (208) 252-5621
- **Practice address fax:** (208) 648-4167
- **Mailing address:** 333 W CEDAR ST STE 3, POCATELLO, ID 83201-5045
- **Mailing address phone:** (208) 252-5621
- **Mailing address fax:** (208) 648-4167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 02/17/2021
- **Last updated:** 02/17/2021