Provider Demographics
NPI:1710766159
Name:HEALTHY MIND BEHAVIORAL HEALTH CLINIC LLC
Entity Type:Organization
Organization Name:HEALTHY MIND BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MUNGA
Authorized Official - Last Name:GAKWA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-284-7100
Mailing Address - Street 1:9428 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8101
Mailing Address - Country:US
Mailing Address - Phone:208-284-7100
Mailing Address - Fax:208-213-3659
Practice Address - Street 1:9428 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8101
Practice Address - Country:US
Practice Address - Phone:208-284-7100
Practice Address - Fax:208-213-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & FamilyGroup - Single Specialty