Organization
AUTOBUS VENTURES, LLC
Active
Other names
Alpine Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY MIDGETT LCSW (OWNER)
(208) 672-0260
Entity
Organization
Contact information
Practice address
8590 W FAIRVIEW AVE STE A, BOISE, ID 83704-8320
(208) 672-0260
(208) 321-7750
Mailing address
8590 W FAIRVIEW AVE STE A, BOISE, ID 83704-8320
(208) 672-0260
(208) 321-7750
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
305S00000X
Point of Service
LCSW-24969
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807585600
—
ID
Enumeration date
01/08/2007
Last updated
01/20/2022
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