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General NPI Number Information
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NPI Number | 1427734524
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Entity Type | Organization
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Legal Business Name | AVANTI MENTAL HEALTH INC
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Dates
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Enumeration Date | 06/23/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1323 AMMON PARK DR
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City | AMMON
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State | ID
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Zip | 83406-4591
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Country | US
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Telephone | 208-534-5447
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Fax | 309-534-5507
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Provider Business Mailing Address
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Address Line | 1323 AMMON PARK DR
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City | AMMON
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State | ID
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Zip | 83406-4591
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Country | US
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Telephone | 208-534-5447
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Fax | 309-534-5507
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Authorized Official
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Title or Position | OWNER
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Name | KIRSTEN L GRIGGS
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Credential | LCPC
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Telephone | 208-534-5447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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