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General NPI Number Information
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NPI Number | 1235706847
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Entity Type | Organization
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Legal Business Name | SAWTOOTH WELLNESS LLC
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 1092 EASTLAND DR N
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City | TWIN FALLS
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State | ID
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Zip | 83301-8442
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Country | US
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Telephone | 208-490-4648
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Fax | 208-400-5310
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Provider Business Mailing Address
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Address Line | PO BOX 5092
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City | TWIN FALLS
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State | ID
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Zip | 83303-5092
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Country | US
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Telephone | 208-490-4648
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Fax | 208-400-5310
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MR. OCTAVIO ARROYO SALDANA
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Credential | MSW, LCSW
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Telephone | 208-490-4648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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