Healthcare Provider Details

I. General information

NPI: 1154233732
Provider Name (Legal Business Name): ANDE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 WILSON AVE
POCATELLO ID
83201-4467
US

IV. Provider business mailing address

780 WILSON AVE
POCATELLO ID
83201-4467
US

V. Phone/Fax

Practice location:
  • Phone: 208-670-6092
  • Fax: 208-759-4791
Mailing address:
  • Phone: 208-670-6092
  • Fax: 208-759-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON BYRD
Title or Position: OWNER
Credential: LCPC
Phone: 208-670-6092