Organization
NORTH IDAHO CHILDREN'S MENTAL HEALTH, PLLC.
Active
Other names
NICMH
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIM BENDICKSON (OFFICE MANAGER)
(208) 265-6798
Entity
Organization
Contact information
Practice address
1717 ONTARIO ST, SANDPOINT, ID 83864-9329
(208) 265-6798
(208) 263-8160
Mailing address
1717 W. ONTARIO ST, SANDPOINT, ID 83864-8268
(208) 265-6798
(208) 263-8160
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-25493
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806106400
—
ID
Enumeration date
12/06/2006
Last updated
05/13/2010
Update your record
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