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General NPI Number Information
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NPI Number | 1245598424
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Entity Type | Organization
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Legal Business Name | COMMUNITY MENTAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 04/25/2012
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Last Update Date | 04/25/2012
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Provider Practice Location Address
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Address Line | 720 E. LANDER
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City | POCATELLO
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State | ID
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Zip | 83201
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Country | US
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Telephone | 208-478-2172
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Fax | 208-478-2174
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Provider Business Mailing Address
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Address Line | 720 E LANDER ST
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City | POCATELLO
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State | ID
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Zip | 83201-6228
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Country | US
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Telephone | 208-478-2172
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Fax | 208-478-2174
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS AMBER DAWN DAVIS
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Credential |
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Telephone | 208-478-2172
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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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