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Organization
PSYCHOLOGICAL PREVENTATIVE HEALTH PLLC
Active
Organization
PSYCHOLOGICAL PREVENTATIVE HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE RICHARSON LCSW (OWNER)
(801) 719-7737
Entity
Organization
Contact information
Practice address
2300 N YELLOWSTONE HWY STE 207, IDAHO FALLS, ID 83401-1652
(801) 719-7737
(888) 887-9784
Mailing address
2184 CHANNING WAY # 157, IDAHO FALLS, ID 83404-8034
(208) 709-3925
(888) 887-9784
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/01/2020
Last updated
02/21/2022
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