Healthcare Provider Details

I. General information

NPI: 1851135040
Provider Name (Legal Business Name): DOUBLE H TRAUMA AND ADDICTION RECOVERY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W CENTER ST # L208
POCATELLO ID
83204-4205
US

IV. Provider business mailing address

845 W CENTER ST # L208
POCATELLO ID
83204-4205
US

V. Phone/Fax

Practice location:
  • Phone: 208-829-3160
  • Fax: 208-242-2302
Mailing address:
  • Phone: 208-829-3160
  • Fax: 208-242-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY C MCLAIN
Title or Position: OWNER
Credential: LCSW
Phone: 208-829-3160