IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME (NPI# 1720118904) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720118904 |
| Entity Type | Organization |
| Organization Name | IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME |
| Practice Address |
2420 American Legion Blvd Mountain Home ID 83647-3146 |
| Mailing Address |
1720 Westgate Dr Suite B-1 Boise ID 83704-7164 |
| Practice Telephone | 2085879061 |
| Practice Fax Number | 2085875024 |
| Mailing Telephone | 2083340894 |
| Mailing Fax Number | 2083340804 |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | GINA WESTCOTT (PROGRAM MANAGER) |
| Authorized Official Telephone | 2083340969 |
| Authorized Official Credential | M.A. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 8073418 | 05 | |
| BLUE SHIELD | 000010018973 | 01 | |
| BLUE CROSS OF IDAHO | HW280 | 01 |
| Street Address |
2420 AMERICAN LEGION BLVD |
| City | MOUNTAIN HOME |
| State | ID |
| Zip Code | 83647-3146 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184104697 | Adriana Crompton | Social Worker | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2018-08-15 |
| 1013425487 | Jaysa Marie Pilant | Social Worker | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2018-01-18 |
| 1619495025 | Clair Therese Wardwell | Social Worker | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2017-09-06 |
| 1013469808 | Melinda Carpenter | Counselor | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2016-10-27 |
| 1306297379 | Jessica Harris | Counselor | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2016-06-30 |
| 1326499120 | John Paul Jones | Counselor | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2016-06-23 |
| 1407217987 | Tiahna E Fairbanks | Developmental Therapist | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2016-03-11 |
| 1174922355 | Nicholas J Arbon | Social Worker | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2014-08-14 |
| 1366851081 | Elizabeth R Loyd | Counselor | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2014-08-06 |
| 1053658138 | Idaho Behavioral Health, Inc. | Family Medicine | 2420 American Legion Blvd, Mountain Home, ID 83647-3146 | 2013-01-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528684370 | The Unruly Tongue Myofunctional Therapy LLC | Specialist | 1125 Nw Bluegrass Cir, Mountain Home, ID 83647 | 2020-06-17 |
| 1740767284 | Kelly Loy | Counselor | 210 North 3rd East, Mountain Home, ID 83647 | 2018-07-27 |
| 1891247912 | Daelene Sueann Tibbitts | Physical Therapy Assistant | 1665 E 5th N, Mountain Home, ID 83647 | 2016-10-25 |
| 1689065765 | Emma Orthel | Counselor | 2240 American Legion Blvd, Mountain Home, ID 83647 | 2015-02-11 |
| 1073692166 | Krzysztof Hendryk Ziola | Internal Medicine | 2280 American Legion Blvd., Mountain Home, ID 83647 | 2006-11-02 |
| 1952482440 | Michael Peter Koelsch | Internal Medicine | 805 North 6th East, Mountain Home, ID 83647 | 2006-10-18 |
| 1124113709 | Talmage W Delange | Counselor | 235 North 3rd East, Mountain Home, ID 83647 | 2006-10-03 |
| 1225044019 | Scott W Sessions | Physical Therapist | 245 N. 3rd, Mountain Home, ID 83647 | 2006-07-31 |
| 1750370730 | Kyle J Kenison | Optometrist | 855 West 6th South, Mountain Home, ID 83647 | 2005-10-21 |
| 1285628156 | Bruce Joseph Siedlecki | Obstetrics & Gynecology | Mtn.home Aif Force Base, Mdos, Mtn. Home, ID 83647 | 2005-09-07 |
| Find all providers in zip 83647 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881252344 | Glenns Ferry Health Center, Inc. | Clinic/Center | 560 E Jackson St, Mountain Home, ID 83647-2824 | 2019-05-30 |
| 1801448840 | Joshua Medley Counseling Pllc | Clinic/Center | 1219 Commerce Dr Ste 3, Mountain Home, AR 72653-2604 | 2019-07-10 |
| 1417518523 | Daniel Grace Counseling and Supervision, Pllc | Clinic/Center | 1219 Commerce Dr Ste 3, Mountain Home, AR 72653-2604 | 2019-06-28 |
| 1427540210 | Roadmaps Counseling and Mediation, Inc. | Clinic/Center | 911 S Baker St, Mountain Home, AR 72653-4711 | 2018-06-06 |
| 1699828657 | Christopher L Winslow Md Pa | Clinic/Center | 400 S College St, Suite # 2, Mountain Home, AR 72653-3923 | 2007-01-20 |
| 1043266315 | Ozark Counseling Services Inc | Clinic/Center | 8 Medical Plz, Mountain Home, AR 72654-1776 | 2006-05-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598364978 | Brave Ahead Counseling | Clinic/Center | 991 Sunset Rd, Athol, ID 83801-9287 | 2020-10-18 |
| 1356959191 | Healing Minds LLC | Clinic/Center | 6586 W Flagstaff St, Rathdrum, ID 83858-8203 | 2020-07-17 |
| 1487273637 | Answers, LLC - Cbrs | Clinic/Center | 855 N Capital Ave Ste 1, Idaho Falls, ID 83402-3405 | 2020-04-08 |
| 1649808767 | Psychological Preventative Health Pllc | Clinic/Center | 4831 Greystone Ln, Idaho Falls, ID 83404-8338 | 2020-04-01 |
| 1073148623 | Begin Within Counseling, LLC | Clinic/Center | 943 W Overland Rd Ste 111, Meridian, ID 83642-6541 | 2020-03-04 |
| 1871126797 | Avanzar Wellness LLC | Clinic/Center | 11513 W Fairview Ave Ste 105, Boise, ID 83713-7887 | 2020-02-19 |
| 1174155741 | Noble Intent | Clinic/Center | 1406 N Main St Ste 204, Meridian, ID 83642-1746 | 2020-02-11 |
| 1194362517 | Advanced Counseling LLC | Clinic/Center | 39 W Pine Ave, Meridian, ID 83642-2281 | 2019-12-04 |
| 1629615406 | Building A Life Worth Living, LLC | Clinic/Center | 771 S Woodruff Ave, Idaho Falls, ID 83401-5286 | 2019-11-29 |
| 1750927281 | Weme Counseling and Clinical Consultation | Clinic/Center | 231 N Third Ave Ste 207, Sandpoint, ID 83864-1418 | 2019-11-19 |
| Find all providers with the same taxonomy | ||||
| City | MOUNTAIN HOME |
| Zip Code | 83647 |
Please comment or provide details below to improve the information on IDAHO DEPT OF HEALTH & WELFARE AMH PSR MT HOME.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.