Organization
PACIFIC MIND INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA JANE VAN LEUVEN LCPC (OWNER/CLINICIAN)
(208) 631-0843
Entity
Organization
Contact information
Practice address
2596 N STOKESBERRY PL STE 165, MERIDIAN, ID 83646-6281
(208) 631-0843
(208) 906-0807
Mailing address
2596 N STOKESBERRY PL STE 165, MERIDIAN, ID 83646-6281
(208) 631-0843
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
09/20/2017
Last updated
07/21/2022
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