Provider Demographics
NPI:1144376245
Name:ACCESS BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ACCESS BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICCOLIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TANGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-713-2424
Mailing Address - Street 1:1276 W. RIVER ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-338-4699
Mailing Address - Fax:208-322-4722
Practice Address - Street 1:1276 W. RIVER ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-338-4699
Practice Address - Fax:208-322-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807043300Medicaid