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General NPI Number Information
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NPI Number | 1790171213
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Entity Type | Organization
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Legal Business Name | CLOUD CLINIC MENTAL HEALTH
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 2577 S FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83709-2325
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Country | US
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Telephone | 208-340-8597
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Fax |
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Provider Business Mailing Address
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Address Line | 3473 E SHERGAR CT
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City | MERIDIAN
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State | ID
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Zip | 83642-3170
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Country | US
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Telephone | 208-340-8597
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON BINDER
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Credential | NP-C
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Telephone | 208-891-6647
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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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