Healthcare Provider Details

I. General information

NPI: 1427511203
Provider Name (Legal Business Name): CENTERPOINTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

IV. Provider business mailing address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

V. Phone/Fax

Practice location:
  • Phone: 208-442-7791
  • Fax: 208-442-7792
Mailing address:
  • Phone: 208-442-7791
  • Fax: 208-442-7791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE KILDOW
Title or Position: CLINIC DIRECTOR/OWNER
Credential:
Phone: 208-442-7791