Organization
IDAHO PSYCHOLOGICAL RESOURCES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXIS SMITH (ADMINSTRATOR)
(208) 604-5193
Entity
Organization
Contact information
Practice address
4433 BEVERLAND ROAD, MACKAY, ID 83251
(208) 588-5770
(208) 588-2984
Mailing address
PO BOX 402, MACKAY, ID 83251-0402
(208) 588-2770
(208) 588-2984
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LPC-3661
ID
104100000X
Social Worker
Primary
LCSW-27821
ID
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/04/2018
Last updated
08/22/2026
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