Organization
OPEN SPACE MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN G RAE IV PMHNP (OWNER)
(307) 690-2938
Entity
Organization
Contact information
Practice address
530 S HOLMES AVE, IDAHO FALLS, ID 83401-5056
(307) 690-2938
Mailing address
PO BOX 955, WILSON, WY 83014-0955
(307) 690-2938
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
12/19/2024
Last updated
12/19/2024
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