# SEQUEL TSI OF IDAHO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SEQUEL TSI HOLDINGS, LLC
- **Other names:** Mountain Home
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891047296
- **Legal business name:** SEQUEL TSI HOLDINGS, LLC
- **Authorized official:** MR. CHRIS BANKEN (SR. VICE PRSIDENT OF OPERATIONS)
- **Authorized official phone:** (602) 335-2095

## Contact information

- **Practice address:** 2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960
- **Practice address phone:** (208) 587-2679
- **Mailing address:** 2850 INDUSTRIAL WAY, MOUNTAIN HOME, ID 83647-3960

## Taxonomy

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

## Other

- **Enumeration date:** 10/09/2012
- **Last updated:** 10/09/2012