Provider Demographics
NPI:1174656664
Name:J&M MENTAL HEALTH, INC.
Entity Type:Organization
Organization Name:J&M MENTAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:208-782-1102
Mailing Address - Street 1:PO BOX 1472
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1472
Mailing Address - Country:US
Mailing Address - Phone:208-782-1102
Mailing Address - Fax:
Practice Address - Street 1:60 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2706
Practice Address - Country:US
Practice Address - Phone:208-782-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty