Healthcare Provider Details

I. General information

NPI: 1629884184
Provider Name (Legal Business Name): BELLA-NACOLE MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N 8TH AVE STE B
POCATELLO ID
83201-5789
US

IV. Provider business mailing address

1111 N 8TH AVE STE B
POCATELLO ID
83201-5789
US

V. Phone/Fax

Practice location:
  • Phone: 208-220-8606
  • Fax:
Mailing address:
  • Phone: 208-220-8606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA OURADA
Title or Position: OWNER
Credential:
Phone: 208-220-8606