# IDAHO DEPT OF HEALTH & WELFARE

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

## Provider details

- **NPI number:** 1689984254
- **Authorized official:** TODD HURT (PROGRAM MANAGER)
- **Authorized official phone:** (208) 455-7057

## Contact information

- **Practice address:** 515 16TH AVE N, PAYETTE, ID 83661-2047
- **Practice address phone:** (208) 642-6412
- **Practice address fax:** (208) 642-2829
- **Mailing address:** 515 16TH AVE N, PAYETTE, ID 83661-2047
- **Mailing address phone:** (208) 642-6412
- **Mailing address fax:** (208) 642-2829

## Taxonomy

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

## Other

- **Enumeration date:** 10/18/2010
- **Last updated:** 10/18/2010