Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Integrated Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1979
(833) 499-1813
Mailing address
1311 E CENTRAL DR, MERIDIAN, ID 83642-7991
(208) 373-1734
(833) 390-1293
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
—
—
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/26/2021
Last updated
03/24/2026
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