# IDAHO DEPT OF HEALTH & WELFARE CMH CLINIC BOISE

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

## Provider details

- **NPI number:** 1205966249
- **Authorized official:** GINA WESTCOTT M.A, (PROGRAM MANAGER)
- **Authorized official phone:** (208) 334-0969

## Contact information

- **Practice address:** 1720 WESTGATE DR, SUITE D, BOISE, ID 83704-7164
- **Practice address phone:** (208) 334-0792
- **Practice address fax:** (208) 334-0812
- **Mailing address:** 1720 WESTGATE DR, SUITE D, BOISE, ID 83704-7164
- **Mailing address phone:** (208) 334-0792
- **Mailing address fax:** (208) 334-0804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/07/2007
- **Last updated:** 08/22/2020