# IDAHO DEPT OF HEALTH & WELFARE REG 6 CMH POC CLINIC

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

## Provider details

- **NPI number:** 1780715045
- **Authorized official:** RITCHIE WEERS (CLINICAL SUPERVISOR)
- **Authorized official phone:** (208) 234-7900

## Contact information

- **Practice address:** 421 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Practice address phone:** (208) 234-7900
- **Practice address fax:** (208) 236-6328
- **Mailing address:** 421 MEMORIAL DR, POCATELLO, ID 83201-4008
- **Mailing address phone:** (208) 234-7900
- **Mailing address fax:** (208) 236-6328

## Taxonomy

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

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 10/22/2010