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Organization
TELEMENTAL HEALTH LINK LLC
Active
Organization
TELEMENTAL HEALTH LINK LLC
Active
Parent organization
PSYCHIATRIC NURSE PRACTITIONER SERVICES LLC
Other names
Psychiatric Nurse Practitioner Services LLC, TELEMENTAL HEALTH LINK - NM
Organization subpart
Yes
Provider details
NPI number
Legal business name
PSYCHIATRIC NURSE PRACTITIONER SERVICES LLC
Authorized official
SUSAN M DERIVAS PMHNP-BC (AO)
(208) 775-7418
Entity
Organization
Contact information
Practice address
4055 E BLUEBERRY ST, MERIDIAN, ID 83642-8261
(208) 775-7418
(208) 647-5008
Mailing address
4055 E BLUEBERRY ST, MERIDIAN, ID 83642-8261
(208) 600-2060
(208) 647-5008
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/27/2020
Last updated
02/07/2024
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