Organization
ALTA ADDICTIONS AND MENTAL HEALTH SERVICES
Active
Other names
Alta Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESA MCCONNEL LCSW (CLINICAL DIRECTOR)
(208) 395-1713
Entity
Organization
Contact information
Practice address
5223 W OVERLAND RD, BOISE, ID 83705-2637
(208) 395-1713
(208) 395-1715
Mailing address
5223 W OVERLAND RD, BOISE, ID 83705-2637
(208) 395-1713
(208) 395-1715
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
LCSW 1100
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8064161
—
ID
Enumeration date
05/09/2007
Last updated
06/12/2008
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