Organization
MOUNTAIN STATES GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARTZELL COBBS (EXECUTIVE DIRECTOR)
(208) 336-5533
Entity
Organization
Contact information
Practice address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 336-0880
Mailing address
1607 W JEFFERSON ST, BOISE, ID 83702-5111
(208) 336-5533
(208) 336-0880
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW2214
ID
Other
Enumeration date
04/26/2007
Last updated
08/22/2020
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