Provider Demographics
NPI:1407061831
Name:NORTHWEST BEHAVIORAL LIFE SKILLS
Entity Type:Organization
Organization Name:NORTHWEST BEHAVIORAL LIFE SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-765-4509
Mailing Address - Street 1:1620 NW BLVD. SUITE 201-C
Mailing Address - Street 2:
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2488
Mailing Address - Country:US
Mailing Address - Phone:208-765-4509
Mailing Address - Fax:208-765-2558
Practice Address - Street 1:1620 NW BLVD. SUITE 201-C
Practice Address - Street 2:
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2488
Practice Address - Country:US
Practice Address - Phone:208-765-4509
Practice Address - Fax:208-765-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health