# IDAHO DEPT OF HEALTH & WELFARE REG 2 CMH

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

## Provider details

- **NPI number:** 1639476294
- **Authorized official:** VICKI MALONE (PROGRAM MANAGER)
- **Authorized official phone:** (208) 799-4440

## Contact information

- **Practice address:** 1350 TROY HIGHWAY, MOSCOW, ID 83843-3995
- **Practice address phone:** (208) 882-0562
- **Mailing address:** 1350 TROY HIGHWAY, MOSCOW, ID 83843-3995
- **Mailing address phone:** (208) 882-0562

## Taxonomy

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

## Other

- **Enumeration date:** 02/17/2011
- **Last updated:** 02/17/2011