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General NPI Number Information
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NPI Number | 1790806065
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Entity Type | Organization
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Legal Business Name | TREASURE VALLEY BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 131 N WHITLEY DR
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City | FRUITLAND
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State | ID
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Zip | 83619-2172
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Country | US
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Telephone | 208-452-7705
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Fax | 208-452-7750
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Provider Business Mailing Address
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Address Line | 131 N WHITLEY DR.
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City | FRUITLAND
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State | ID
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Zip | 83619
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Country | US
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Telephone | 208-452-7705
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Fax | 208-452-7750
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Authorized Official
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Title or Position | OWNER /THERAPIST
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Name | BRADI FRITTS
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Credential | LMSW
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Telephone | 208-452-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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