Healthcare Provider Details

I. General information

NPI: 1407870900
Provider Name (Legal Business Name): SALMON MENTAL HEALTH CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LILLIAN ST SUITE 101
SALMON ID
83467-4301
US

IV. Provider business mailing address

111 LILLIAN ST SUITE 101
SALMON ID
83467-4301
US

V. Phone/Fax

Practice location:
  • Phone: 208-756-1573
  • Fax: 208-756-1579
Mailing address:
  • Phone: 208-756-1573
  • Fax: 208-756-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA J BAGLIEN
Title or Position: CO OWNER CHAIRMAN
Credential: PH D
Phone: 208-756-1573