NPI 1023145893

Idaho Dept of Health & Welfare Reg 1 Amh Psr Cda

Organisation Mental Health Clinic/Center (Including Community Mental Health Center) Coeur D Alene, ID

Practice location

Address: 2195 Ironwood CT, Coeur D Alene, ID 83814-2628
Phone: (208) 769-1406
Fax: (208) 769-1430

Authorised official

Name: Cora Jo Gussenhoven
Title: Program Manager
Phone: (208) 769-1406

Registered specialties

Mental Health Clinic/Center (Including Community Mental Health Center) Primary

Ambulatory Health Care Facilities Taxonomy 261QM0801X

Other Clinic/Center providers in Idaho →

Registry record

NPI: 1023145893
Entity type: Organization
NPI issued: 27 Feb 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.