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General NPI Number Information
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NPI Number | 1043368418
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Entity Type | Organization
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Legal Business Name | MOUNTAIN STATES CHEMICAL DEPENDENCY AND COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 1305 2ND ST S SUITE 201
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City | NAMPA
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State | ID
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Zip | 83651-3944
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Country | US
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Telephone | 208-463-0202
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Fax | 208-463-0205
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Provider Business Mailing Address
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Address Line | 1305 2ND ST SOUTH SUITE 201
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City | NAMPA
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State | ID
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Zip | 83651-3964
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Country | US
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Telephone | 208-463-0202
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Fax | 208-463-0205
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RUSTY O'LEARY
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Credential | LCPC
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Telephone | 208-463-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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