Provider Demographics
NPI:1740583590
Name:SEASONS OF HOPE PSYCHOLOGICAL ASSESMENT AND TREATMENT CENTER
Entity Type:Organization
Organization Name:SEASONS OF HOPE PSYCHOLOGICAL ASSESMENT AND TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SOMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-237-9833
Mailing Address - Street 1:4650 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2376
Mailing Address - Country:US
Mailing Address - Phone:208-237-9833
Mailing Address - Fax:208-237-1800
Practice Address - Street 1:4650 HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2376
Practice Address - Country:US
Practice Address - Phone:208-237-9833
Practice Address - Fax:208-237-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY202423261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)