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General NPI Number Information
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NPI Number | 1851423446
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Entity Type | Organization
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Legal Business Name | PANHANDLE BEHAVIOAL HEALTH
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 212 S 11TH ST SUITE 5
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City | COEUR D ALENE
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State | ID
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Zip | 83814-4000
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Country | US
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Telephone | 208-755-6121
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Fax | 208-667-2681
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Provider Business Mailing Address
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Address Line | 32126 ALLISON RD
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City | ST IGNATIUS
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State | MT
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Zip | 59865-9155
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Country | US
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Telephone | 406-745-0148
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Fax | 208-667-2681
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK ELMO WRIGHT
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Credential | PH.D.
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Telephone | 406-745-0148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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