Provider Demographics
NPI:1790081032
Name:SENSITIVE MENTAL HEALTHCARE PLLC
Entity Type:Organization
Organization Name:SENSITIVE MENTAL HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:208-818-1411
Mailing Address - Street 1:419 N BRUSHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6764
Mailing Address - Country:US
Mailing Address - Phone:208-818-1411
Mailing Address - Fax:
Practice Address - Street 1:7905 N MEADOWLARK WAY
Practice Address - Street 2:SUITE B
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-818-1411
Practice Address - Fax:208-772-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-999A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12224429OtherCAQH
036263OtherREGENCE
ID1790081032Medicaid
8P321OtherBLUE CROSS
ID1790081032Medicaid