=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972626620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R H MENTAL HEALTH SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 06/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 S ORCHARD ST SUITE 290
-----------------------------------------------------
City | BOISE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83705-1966
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-343-2770
-----------------------------------------------------
Fax | 208-343-2720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16703 N YORKSHIRE LN
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83687-9437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-371-7089
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RICK A HEIKKILA
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 208-371-7089
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW-25602
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------