Healthcare Provider Details

I. General information

NPI: 1235562604
Provider Name (Legal Business Name): HEALTHY RESOLUTIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MCKINLEY AVE
KELLOGG ID
83837-2567
US

IV. Provider business mailing address

135 MCKINLEY AVE
KELLOGG ID
83837-2567
US

V. Phone/Fax

Practice location:
  • Phone: 208-786-7040
  • Fax: 208-682-9952
Mailing address:
  • Phone: 208-786-7040
  • Fax: 208-682-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0-246
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number26450
License Number StateID

VIII. Authorized Official

Name: DR. CONNIE C. HAHN
Title or Position: AGENCY DIRECTOR
Credential: PH.D.
Phone: 208-786-7040