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General NPI Number Information
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NPI Number | 1588810535
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Entity Type | Organization
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Legal Business Name | ALA, LLC
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 818 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 | 208-234-2094
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Fax | 208-234-2637
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Provider Business Mailing Address
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Address Line | 818 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 | 208-234-2094
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Fax | 208-234-2637
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Authorized Official
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Title or Position | CEO/PSYCHOLOGIST
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Name | MS. CHERI L ATKINS
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Credential | PHD
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Telephone | 208-234-2094
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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 | PSY-202272
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License Number State | ID
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