Provider Demographics
NPI:1821215963
Name:RELIANCE MENTAL HEALTH PC
Entity Type:Organization
Organization Name:RELIANCE MENTAL HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PARRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-478-2172
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-0328
Mailing Address - Country:US
Mailing Address - Phone:208-478-2172
Mailing Address - Fax:208-478-2174
Practice Address - Street 1:328 W CLARK ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3148
Practice Address - Country:US
Practice Address - Phone:208-478-2172
Practice Address - Fax:208-478-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty