Organization
MOUNTAIN RIVER MENTAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE HAMPTON MSW (PRESIDENT SOCIAL WORKER)
(208) 522-8899
Entity
Organization
Contact information
Practice address
3767 PROFESSIONAL WAY, IDAHO FALLS, ID 83402-7315
(208) 522-8899
(208) 522-6596
Mailing address
PO BOX 2106, IDAHO FALLS, ID 83403-2106
(208) 522-8899
(208) 522-6596
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806612700
—
ID
Enumeration date
03/11/2007
Last updated
05/21/2008
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