Healthcare Provider Details

I. General information

NPI: 1780191213
Provider Name (Legal Business Name): NEW HORIZONS MENTAL WELLNESS CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2018
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SPRAGUE AVE
BUHL ID
83316-1827
US

IV. Provider business mailing address

PO BOX 4789
POCATELLO ID
83205-4789
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-2025
  • Fax: 208-233-2178
Mailing address:
  • Phone: 208-233-2025
  • Fax: 208-233-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTA BATTS
Title or Position: BILLING
Credential:
Phone: 208-244-6437