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Organization
CANVI BEHAVIORAL HEALTH PLLC
Active
Organization
CANVI BEHAVIORAL HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA BATTS (CONTRACTING MANAGER)
(208) 380-4978
Entity
Organization
Contact information
Practice address
4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
(208) 252-5621
(208) 648-4167
Mailing address
PO BOX 2516, POCATELLO, ID 83206-2516
(208) 380-4978
(208) 648-4063
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/28/2021
Last updated
04/12/2024
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