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General NPI Number Information
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NPI Number | 1750985032
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Entity Type | Organization
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Legal Business Name | IDAHO MENTAL WELLNESS & ADDICTION RECOVERY PLLC
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Dates
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Enumeration Date | 11/26/2020
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Last Update Date | 04/07/2021
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Provider Practice Location Address
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Address Line | 1516 PRIMROSE DR
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City | NAMPA
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State | ID
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Zip | 83686-8582
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Country | US
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Telephone | 208-697-1075
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Fax | 208-906-8520
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Provider Business Mailing Address
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Address Line | 1516 PRIMROSE DR
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City | NAMPA
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State | ID
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Zip | 83686-8582
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Country | US
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Telephone | 208-697-1075
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Fax | 208-906-8520
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT WATKINS
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Credential | PMHNP-BC
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Telephone | 208-697-1075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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