# IDAHO DEPT OF HEALTH & WELFARE REGION 7 CMH CLINIC IF

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1629104047
- **Authorized official:** MRS. MELISSA M BEAN MA (PROGRAM MANAGER)
- **Authorized official phone:** (208) 528-5706

## Contact information

- **Practice address:** 150 SHOUP AVE, SUITE 17, IDAHO FALLS, ID 83402-3657
- **Practice address phone:** (208) 528-5700
- **Practice address fax:** (208) 528-5747
- **Mailing address:** 150 SHOUP AVE, SUITE 17, IDAHO FALLS, ID 83402-3657
- **Mailing address phone:** (208) 528-5700
- **Mailing address fax:** (208) 528-5747

## Taxonomy

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

## Other

- **Enumeration date:** 02/27/2007
- **Last updated:** 08/22/2020