=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154233732
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDE BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2026
-----------------------------------------------------
Last Update Date | 09/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 780 WILSON AVE
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83201-4467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-670-6092
-----------------------------------------------------
Fax | 208-759-4791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 WILSON AVE
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83201-4467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-670-6092
-----------------------------------------------------
Fax | 208-759-4791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JASON BYRD
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 208-670-6092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------