Healthcare Provider Details

I. General information

NPI: 1447452800
Provider Name (Legal Business Name): BLMH MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 WASHINGTON ST STE 2
MONTPELIER ID
83254-1600
US

IV. Provider business mailing address

455 WASHINGTON ST STE 2
MONTPELIER ID
83254-1600
US

V. Phone/Fax

Practice location:
  • Phone: 208-847-4464
  • Fax: 208-847-3093
Mailing address:
  • Phone: 208-847-4464
  • Fax: 208-847-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number35
License Number StateID

VIII. Authorized Official

Name: SHAE JAYDEN KUNZ
Title or Position: OFFICE MANAGER/CREDENTIALING
Credential:
Phone: 208-847-4464