Organization
HAVEN BEHAVIORAL OUTPATIENT SERVICES OF BOISE, LLC
Active
Other names
Cottonwood Creek Wellness Center - Lost River
Organization subpart
No
Provider details
NPI number
Authorized official
JANIE PICKLE (VP, CONTROLLER)
(615) 393-8809
Entity
Organization
Contact information
Practice address
1919 W STATE ST, BOISE, ID 83702-3958
(208) 813-6246
Mailing address
3102 W END AVE STE 1000, NASHVILLE, TN 37203-1324
(615) 393-8800
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
05/24/2019
Last updated
03/22/2022
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