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General NPI Number Information
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NPI Number | 1447426465
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Entity Type | Organization
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Legal Business Name | PEARL HEALTH CLINIC
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 2705 E 17TH ST
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City | AMMON
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State | ID
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Zip | 83406-6601
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Country | US
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Telephone | 208-346-7500
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Fax | 208-346-7501
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Provider Business Mailing Address
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Address Line | 2705 E 17TH ST
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City | AMMON
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State | ID
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Zip | 83406-6669
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Country | US
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Telephone | 208-346-7500
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Fax | 208-346-7501
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Authorized Official
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Title or Position | OWNER
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Name | ZAKERY WARREN
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Credential |
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Telephone | 208-346-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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