Organization
AMBITIONS OF IDAHO, INC
Active
Other names
Ambitions
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE HAGEL (PRESIDENT)
(208) 930-1740
Entity
Organization
Contact information
Practice address
1044 NORTHWEST BLVD STE C, COEUR D ALENE, ID 83814-2114
(208) 930-1740
(208) 930-1695
Mailing address
1044 NORTHWEST BLVD STE C, COEUR D ALENE, ID 83814-2114
(208) 930-1740
(208) 930-1695
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8079051
—
ID
Enumeration date
12/11/2009
Last updated
10/12/2023
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