Organization
PORTNEUF VALLEY FAMILY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT DE WALL (OWNER/ADMINISTRATOR)
(208) 233-7832
Entity
Organization
Contact information
Practice address
444 HOSPITAL WAY STE 477, POCATELLO, ID 83201-2744
(208) 233-7832
(208) 233-7835
Mailing address
444 HOSPITAL WAY STE 477, POCATELLO, ID 83201-2744
(208) 233-7832
(208) 233-7835
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
104100000X
Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
09/16/2006
Last updated
06/27/2025
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