Provider Demographics
NPI:1558828236
Name:CENTERPOINT PSYCHIATRY AND FAMILY PRACTICE
Entity Type:Organization
Organization Name:CENTERPOINT PSYCHIATRY AND FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-359-4840
Mailing Address - Street 1:393 E 2ND N
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-1605
Mailing Address - Country:US
Mailing Address - Phone:208-359-4840
Mailing Address - Fax:208-359-9010
Practice Address - Street 1:393 E 2ND N
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-1605
Practice Address - Country:US
Practice Address - Phone:208-359-4840
Practice Address - Fax:208-359-9010
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERPOINT COUNSELING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty