Organization
MOUNTAIN WEST SUPPORTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KALLE STEPHANIE SMITH LSW (OWNER)
(208) 715-0218
Entity
Organization
Contact information
Practice address
1970 E 17TH ST STE 101, IDAHO FALLS, ID 83404-8046
(208) 715-0218
(208) 715-0210
Mailing address
1970 E 17TH ST STE 101, IDAHO FALLS, ID 83404-8046
(208) 715-0218
(208) 715-0210
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/16/2018
Last updated
05/16/2018
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