Healthcare Provider Details

I. General information

NPI: 1215432539
Provider Name (Legal Business Name): BELLA-NACOLE MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 N 8TH AVE
POCATELLO ID
83201-5718
US

IV. Provider business mailing address

850 E YOUNG ST
POCATELLO ID
83201-5736
US

V. Phone/Fax

Practice location:
  • Phone: 208-226-4943
  • Fax: 208-242-3892
Mailing address:
  • Phone: 208-220-8606
  • Fax: 208-242-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. WENDY JO WEBB
Title or Position: OWNER
Credential:
Phone: 208-226-4943