Organization
MENTAL HEALTH CLINIC OF IDAHO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SAMI PHUYAL FNP (PROVIDER/OWNER)
(979) 332-4184
Entity
Organization
Contact information
Practice address
6737 E DEER RIDGE ST, BOISE, ID 83716-7147
(979) 332-4184
Mailing address
6737 E DEER RIDGE ST, BOISE, ID 83716-7147
(979) 332-4184
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760157598
NPI
ID
Enumeration date
04/07/2023
Last updated
04/18/2023
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