Healthcare Provider Details

I. General information

NPI: 1659991495
Provider Name (Legal Business Name): MVHC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 11/27/2023
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N ALLUMBAUGH ST
BOISE ID
83704-9208
US

IV. Provider business mailing address

2321 E GALA ST STE 3
MERIDIAN ID
83642-7692
US

V. Phone/Fax

Practice location:
  • Phone: 208-888-5848
  • Fax: 208-888-0884
Mailing address:
  • Phone: 208-888-5848
  • Fax: 208-888-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATIE S GILLIES
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-888-5848