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General NPI Number Information
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NPI Number | 1801000112
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Entity Type | Organization
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Legal Business Name | ALTA ADDICTIONS AND MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 5223 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83705-2637
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Country | US
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Telephone | 208-395-1713
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Fax | 208-395-1715
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Provider Business Mailing Address
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Address Line | 5223 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83705-2637
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Country | US
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Telephone | 208-395-1713
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Fax | 208-395-1715
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. LESA MCCONNEL
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Credential | LCSW
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Telephone | 208-395-1713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCSW 1100
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License Number State | ID
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