Organization
IDAHO STATE UNIVERSITY
Active
Other names
ISU Community Psychiatric Center
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA LEE ROCK (CLINICS DIRECTOR OF OPERATIONS)
(208) 373-1743
Entity
Organization
Contact information
Practice address
421 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 373-1743
(833) 499-1813
Mailing address
921 S 8TH AVE STOP 8311, POCATELLO, ID 83201-5377
(208) 373-1743
(833) 499-1813
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
01/09/2024
Last updated
02/27/2024
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