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General NPI Number Information
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NPI Number | 1619534609
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Entity Type | Organization
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Legal Business Name | HAVEN BEHAVIORAL OUTPATIENT SERVICES OF BOISE, LLC
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 1919 W STATE ST
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City | BOISE
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State | ID
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Zip | 83702-3958
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Country | US
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Telephone | 208-813-6246
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Fax |
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Provider Business Mailing Address
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Address Line | 3102 W END AVE STE 1000
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City | NASHVILLE
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State | TN
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Zip | 37203-1324
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Country | US
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Telephone | 615-393-8800
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Fax |
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Authorized Official
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Title or Position | VP, CONTROLLER
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Name | JANIE PICKLE
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Credential |
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Telephone | 615-393-8809
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 2084P0800X
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Taxonomy Name | 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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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