Provider Demographics
NPI:1780826594
Name:ALLIED MENTAL HEALTH SERVICES, P.L.L.C.
Entity Type:Organization
Organization Name:ALLIED MENTAL HEALTH SERVICES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:208-286-7967
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:STAR
Mailing Address - State:ID
Mailing Address - Zip Code:83669-0545
Mailing Address - Country:US
Mailing Address - Phone:208-286-7967
Mailing Address - Fax:208-286-9047
Practice Address - Street 1:11104 W. STATE ST.
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669
Practice Address - Country:US
Practice Address - Phone:208-286-7967
Practice Address - Fax:208-286-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health