Healthcare Provider Details

I. General information

NPI: 1013204957
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES BEHAVIORAL HEALTH CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DR
TWIN FALLS ID
83301-7480
US

IV. Provider business mailing address

PO BOX 47
TWIN FALLS ID
83303-0047
US

V. Phone/Fax

Practice location:
  • Phone: 208-732-0995
  • Fax: 208-732-0993
Mailing address:
  • Phone: 208-732-0995
  • Fax: 208-732-0993

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: CARMEN BABB
Title or Position: OWNER
Credential: MA, CADC
Phone: 208-732-0995