Organization
STATE OF MIND COUNSELING AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA SMITH (LPC)
(208) 602-2293
Entity
Organization
Contact information
Practice address
141 N PALMETTO AVE UNIT 1626, EAGLE, ID 83616-8066
(208) 939-3999
Mailing address
233 W STATE ST STE D, EAGLE, ID 83616-4982
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
4841
ID
261QM0850X
Adult Mental Health Clinic/Center
4841
ID
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
4841
ID
Other
Enumeration date
05/22/2012
Last updated
07/27/2012
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