Organization
PRIDE MENTAL HEALTH
Active
Other names
Pride Mental Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANE M. MULLEN B.S., CPRP (OWNER/OPERATOR)
(208) 322-2928
Entity
Organization
Contact information
Practice address
9488 W FAIRVIEW AVE, BOISE, ID 83704-8101
(208) 322-2929
(208) 322-2983
Mailing address
9488 W FAIRVIEW AVE, BOISE, ID 83704-8101
(208) 322-2928
(208) 322-2983
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
05/01/2017
Last updated
09/18/2024
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