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General NPI Number Information
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NPI Number | 1073660320
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Entity Type | Organization
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Legal Business Name | PRIESTLEY MENTAL HEALTH INC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/07/2013
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Provider Practice Location Address
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Address Line | 75 S 1ST W
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City | PRESTON
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State | ID
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Zip | 83263-1259
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Country | US
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Telephone | 208-852-2370
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Fax | 208-852-5570
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | FRANKLIN
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State | ID
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Zip | 83237-0054
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | DAVID PRIESTLEY
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Credential |
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Telephone | 208-339-0227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 26656
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License Number State | ID
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