Provider Demographics
NPI:1225581853
Name:IDAHO DEPT HEALTH AND WELFARE
Entity Type:Organization
Organization Name:IDAHO DEPT HEALTH AND WELFARE
Other - Org Name:REGION II BEHAVIORAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:BEHAVIORAL HEALTH PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-799-4440
Mailing Address - Street 1:1350 TROY RD
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3995
Mailing Address - Country:US
Mailing Address - Phone:208-882-0562
Mailing Address - Fax:208-882-8575
Practice Address - Street 1:1350 TROY RD
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3995
Practice Address - Country:US
Practice Address - Phone:208-882-0562
Practice Address - Fax:208-882-8575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6278251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health