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Organization
PANHANDLE BEHAVIOAL HEALTH
Active
Organization
PANHANDLE BEHAVIOAL HEALTH
Active
Other names
Panhandle Horizons
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK ELMO WRIGHT PH.D. (OWNER)
(406) 745-0148
Entity
Organization
Contact information
Practice address
212 S 11TH ST, SUITE 5, COEUR D ALENE, ID 83814-4000
(208) 755-6121
(208) 667-2681
Mailing address
32126 ALLISON RD, ST IGNATIUS, MT 59865-9155
(406) 745-0148
(208) 667-2681
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806144500
—
ID
01
—
PSY90
PSYCHOLOGY LICENSE
ID
Enumeration date
03/10/2007
Last updated
08/07/2008
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