# REGENTS OF THE UNIVERSITY OF IDAHO CHILD & YOUTH STUDY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Child & Youth Study Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609902980
- **Authorized official:** DR. GWEN ELAINE MITCHELL LPC, NCSP (DIRECTOR)
- **Authorized official phone:** (208) 885-6191

## Contact information

- **Practice address:** 121 WEST SWEET AVENUE, MOSCOW, ID 83843
- **Practice address phone:** (208) 885-6191
- **Practice address fax:** (208) 885-6188
- **Mailing address:** 875 PERIMETER DRIVE, MS 4061, MOSCOW, ID 83844-4061
- **Mailing address phone:** (208) 885-3588
- **Mailing address fax:** (208) 885-3536

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2007
- **Last updated:** 04/01/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 807220700 | — | ID |