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Organization
IDAHO STATE UNIVERSITY
Active
Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Community Psychiatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 373-1743
(833) 499-1813
Mailing address
921 S 8TH AVE STOP 8311, POCATELLO, ID 83201-5377
(208) 373-1743
(833) 499-1813
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
02/27/2024
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