Healthcare Provider Details

I. General information

NPI: 1023435526
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES BEHAVIORAL HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 EASTLAND DRIVE
TWIN FALLS ID
83301
US

IV. Provider business mailing address

493 EASTLAND DRIVE
TWIN FALLS ID
83301
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 Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARMEN D BABB
Title or Position: OWNER
Credential:
Phone: 208-732-0995