Whalio Doctors

NPI 1043556608

Latino Stand Up Idaho LLC

Organisation Mental Health Clinic/Center (Including Community Mental Health Center) Idaho Falls, ID

Practice location

Address
1680 Woodruff Park, Idaho Falls, ID 83401-3330
Phone
(208) 552-6373
Fax
(208) 552-2188

Authorised official

Name
Roger Horne
Title
Owner
Phone
(910) 573-0861

Registered specialties (8)

Mental Health Clinic/Center (Including Community Mental Health Center) Primary
Ambulatory Health Care Facilities Taxonomy 261QM0801X
Child & Adolescent Psychiatry Physician
Allopathic & Osteopathic Physicians Taxonomy 2084P0804X
Case Management Agency
Agencies Taxonomy 251B00000X
Community/Behavioral Health Agency
Agencies Taxonomy 251S00000X
Adult Mental Health Clinic/Center
Ambulatory Health Care Facilities Taxonomy 261QM0850X
Substance Use Disorder Rehabilitation Clinic/Center
Ambulatory Health Care Facilities Taxonomy 261QR0405X
Medical Physician Assistant
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X
Clinical Nurse Specialist
Physician Assistants & Advanced Practice Nursing Providers Taxonomy 364S00000X

Registry record

NPI
1043556608
Entity type
Organization
NPI issued
28 Dec 2012
Record last updated
23 May 2013

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.