Provider Demographics
NPI:1790171213
Name:CLOUD CLINIC MENTAL HEALTH
Entity Type:Organization
Organization Name:CLOUD CLINIC MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:208-891-6647
Mailing Address - Street 1:3473 E SHERGAR CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3170
Mailing Address - Country:US
Mailing Address - Phone:208-340-8597
Mailing Address - Fax:
Practice Address - Street 1:2577 S FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2325
Practice Address - Country:US
Practice Address - Phone:208-340-8597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)