Organization
UNIVERSITY OF IDAHO
Active
Other names
CDHD Behavioral Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN HOUSE (MEDICAID BILLING)
(208) 885-3771
Entity
Organization
Contact information
Practice address
129 WEST THIRD ST., MOSCOW, ID 83843-0000
(208) 885-3771
(208) 885-3628
Mailing address
129 WEST THIRD ST., MOSCOW, ID 83843-0000
(208) 885-3771
(208) 885-3628
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002821300
—
ID
Enumeration date
03/30/2007
Last updated
06/12/2008
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