Organization
AUTUMN LEAVES PSYCHIATRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERJURIE F RICKLEFS ARNP, PMHNP-BC (PSYCHIATRIC NURSE PRACTITIONER)
(208) 821-0357
Entity
Organization
Contact information
Practice address
3670 S 25TH E STE 4, IDAHO FALLS, ID 83404-4956
(208) 821-0357
Mailing address
3670 S 25TH E STE 4, IDAHO FALLS, ID 83404-4956
(208) 821-0357
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/15/2021
Last updated
05/06/2021
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