Provider Demographics
NPI:1346759495
Name:PACIFIC MIND INSTITUTE
Entity Type:Organization
Organization Name:PACIFIC MIND INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:VAN LEUVEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-631-0843
Mailing Address - Street 1:2596 N STOKESBERRY PL STE 165
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6281
Mailing Address - Country:US
Mailing Address - Phone:208-631-0843
Mailing Address - Fax:
Practice Address - Street 1:2596 N STOKESBERRY PL STE 165
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6281
Practice Address - Country:US
Practice Address - Phone:208-631-0843
Practice Address - Fax:208-906-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health