Organization
REGENTS OF THE UNIVERSITY OF IDAHO CHILD & YOUTH STUDY CENTER
Active
Other names
Child & Youth Study Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GWEN ELAINE MITCHELL LPC, NCSP (DIRECTOR)
(208) 885-6191
Entity
Organization
Contact information
Practice address
121 WEST SWEET AVENUE, MOSCOW, ID 83843
(208) 885-6191
(208) 885-6188
Mailing address
875 PERIMETER DRIVE, MS 4061, MOSCOW, ID 83844-4061
(208) 885-3588
(208) 885-3536
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807220700
—
ID
Enumeration date
02/23/2007
Last updated
04/01/2014
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