Provider Demographics
NPI:1144396649
Name:NORTH IDAHO TREATMENT ASSOCIATES
Entity Type:Organization
Organization Name:NORTH IDAHO TREATMENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HEARN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:208-664-3282
Mailing Address - Street 1:302 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2814
Mailing Address - Country:US
Mailing Address - Phone:208-664-3282
Mailing Address - Fax:
Practice Address - Street 1:302 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2814
Practice Address - Country:US
Practice Address - Phone:208-664-3282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 4031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty