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General NPI Number Information
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NPI Number | 1760268791
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Entity Type | Organization
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Legal Business Name | A HEALTHY MIND, LLC
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 414 N LINCOLN AVE STE 4
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City | JEROME
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State | ID
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Zip | 83338-2300
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Country | US
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Telephone | 208-969-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 725 IDAHO ST
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City | GOODING
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State | ID
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Zip | 83330-1535
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Country | US
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Telephone | 208-969-1002
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA REBOLLEDO
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Credential |
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Telephone | 208-969-1002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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