Provider Demographics
NPI:1104214618
Name:PERMA MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:PERMA MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-319-3513
Mailing Address - Street 1:950 W BANNOCK ST
Mailing Address - Street 2:STE. 1100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5999
Mailing Address - Country:US
Mailing Address - Phone:208-996-1700
Mailing Address - Fax:208-350-6674
Practice Address - Street 1:950 W BANNOCK ST
Practice Address - Street 2:STE. 1100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5999
Practice Address - Country:US
Practice Address - Phone:208-319-3513
Practice Address - Fax:208-350-6674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMD 125002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20005246Medicare PIN