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Organization
IDAHO DEPT OF HEALTH & WELFARE
Active
Organization
IDAHO DEPT OF HEALTH & WELFARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD HURT (PROGRAM MANAGER)
(208) 455-7057
Entity
Organization
Contact information
Practice address
515 16TH AVE N, PAYETTE, ID 83661-2047
(208) 642-6412
(208) 642-2829
Mailing address
515 16TH AVE N, PAYETTE, ID 83661-2047
(208) 642-6412
(208) 642-2829
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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