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General NPI Number Information
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NPI Number | 1518192970
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Entity Type | Organization
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Legal Business Name | A BETTER LIFE MENTAL HEALTH AND ADDICTIONS SERVICES
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 2309 N MOUNTAIN VIEW DR SUITE#167
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City | BOISE
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State | ID
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Zip | 83706-1000
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Country | US
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Telephone | 208-703-0585
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Fax |
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Provider Business Mailing Address
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Address Line | 2309 N MOUNTAIN VIEW DR SUITE#167
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City | BOISE
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State | ID
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Zip | 83706-1000
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Country | US
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Telephone | 208-703-0585
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JASMINE LAUREL JOHNSON
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Credential | LSW/CADC
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Telephone | 208-703-0585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | ID
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