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General NPI Number Information
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NPI Number | 1922879394
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Entity Type | Organization
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Legal Business Name | AZURE STONE MENTAL HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 01/12/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 2000 S EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6707
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Country | US
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Telephone | 208-623-8099
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 LEGACY DR
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City | POCATELLO
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State | ID
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Zip | 83201-7916
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Country | US
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Telephone | 208-623-8099
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL SPRINGER
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Credential |
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Telephone | 208-623-8099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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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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