Organization
PACIFIC MENTAL HEALTH IDAHO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSY HOAG (CREDENTIALING SPECIALIST)
(425) 361-2273
Entity
Organization
Contact information
Practice address
1617 CLEVELAND BLVD, CALDWELL, ID 83605-5029
(425) 582-2041
(425) 527-0468
Mailing address
5108 196TH ST SW STE 350, C/O RXDX MEDICAL BILLING SERVICES LLC, STE 310, LYNNWOOD, WA 98036-6169
(425) 361-2273
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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