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Organization

STATE OF IDAHO DEPARTMENT OF HEALTH AND WELFARE

Active
Parent organization
STATE OF IDAHO DEPARTMENT OF HEALTH AND WEL
Other names
SHS Psychiatric Group
Organization subpart
Yes

Provider details

NPI number
Legal business name
STATE OF IDAHO DEPARTMENT OF HEALTH AND WEL
Authorized official
MS. LYNN D SHIELDS (PATIENT ACCOUNT SPEC)
(208) 785-8462
Entity
Organization

Contact information

Practice address
700 EAST ALICE, BLACKFOOT, ID 83221
(208) 785-8462
Mailing address
P.O. BOX 400, BLACKFOOT, ID 83221
(208) 785-8462
(208) 785-8518

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
103TC0700X
Clinical Psychologist

Other

Enumeration date
02/11/2015
Last updated
03/25/2015
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