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NPI Code Detail

MEDICARE: ACCESS BEHAVIORAL HEALTH SERVICES

MEDICARE: ACCESS BEHAVIORAL HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/CenterLPC-4515ID

General Provider Information

NPI Number : 1821376773
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACCESS BEHAVIORAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 1276 W RIVER ST
Second Line :
City : BOISE
State : ID
Zip : 83702-7066
Country : US
Telephone Number : 208-322-4722
Fax Number :
Provider Business Practice Location Address
First Line : 1276 W RIVER ST STE 100
Second Line :
City : BOISE
State : ID
Zip : 83702-7083
Country : US
Telephone Number : 208-322-4722
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. NIKKI TANGEN
Credential :
Telephone Number : 208-322-4722
Provider Enumeration Date : 07/26/2011
Last Update Date : 07/26/2011

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Directions to “ACCESS BEHAVIORAL HEALTH SERVICES ” Practice Location

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