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General NPI Number Information
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NPI Number | 1548585458
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH SPECIALISTS
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Dates
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Enumeration Date | 04/02/2010
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 210 W BURNSIDE AVE SUITE A
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City | CHUBBUCK
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State | ID
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Zip | 83202-4916
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Country | US
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Telephone | 208-238-9000
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Fax | 208-238-9002
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Provider Business Mailing Address
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Address Line | 210 W BURNSIDE AVE SUITE A
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City | CHUBBUCK
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State | ID
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Zip | 83202-4916
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Country | US
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Telephone | 208-238-9000
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Fax | 208-238-9002
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. RICHARD J BOYCE
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Credential | LCSW
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Telephone | 208-238-9000
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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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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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