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General NPI Number Information
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NPI Number | 1710766159
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Entity Type | Organization
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Legal Business Name | HEALTHY MIND BEHAVIORAL HEALTH CLINIC LLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 9492 W FAIRVIEW AVE
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City | BOISE
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State | ID
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Zip | 83704-8101
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Country | US
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Telephone | 208-284-7100
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Fax | 208-213-3659
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Provider Business Mailing Address
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Address Line | 9492 W FAIRVIEW AVE
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City | BOISE
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State | ID
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Zip | 83704-8101
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Country | US
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Telephone | 208-284-7100
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Fax | 208-213-3659
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Authorized Official
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Title or Position | PMHNP
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Name | CHRISTOPHER MUNGA GAKWA
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Credential | NP
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Telephone | 208-284-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0810X
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Taxonomy Name | Child & Family Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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