Organization
MENTAL WELLNESS CLINIC OF COEUR D ALENE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY P LAGROU BA (OWNER PROGRAM MANAGER)
(208) 676-1003
Entity
Organization
Contact information
Practice address
500 N GOVERNMENT WAY, SUITE 100, COEUR D ALENE, ID 83814-2913
(208) 676-1003
(208) 676-1009
Mailing address
500 N GOVERNMENT WAY, SUITE 100, COEUR D ALENE, ID 83814-2913
(208) 676-1003
(208) 676-1009
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/20/2007
Last updated
09/11/2025
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