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Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Integrated Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1979
(833) 499-1813
Mailing address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1734
(833) 390-1293
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
—
NULL
103TP0016X
Prescribing (Medical) Psychologist
—
—
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
—
—
1835P2201X
Ambulatory Care Pharmacist
—
NULL
1835P2201X
Ambulatory Care Pharmacist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
NULL
3336S0011X
Specialty Pharmacy
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/26/2021
Last updated
07/13/2026
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