Organization
REGENERIZE PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RADLEY PETERSON (OWNER)
(208) 899-5997
Entity
Organization
Contact information
Practice address
605 S OLIVE AVE, SANDPOINT, ID 83864-1154
(209) 677-7747
Mailing address
605 S OLIVE AVE, SANDPOINT, ID 83864-1154
(208) 606-0620
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
06/24/2024
Last updated
10/27/2024
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