Provider Demographics
NPI:1649093824
Name:ALLIANCE PSYCHIATRIC WELLNESS, PLLC
Entity type:Organization
Organization Name:ALLIANCE PSYCHIATRIC WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GERSTENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:208-946-8044
Mailing Address - Street 1:PO BOX 618
Mailing Address - Street 2:
Mailing Address - City:CLARK FORK
Mailing Address - State:ID
Mailing Address - Zip Code:83811-0618
Mailing Address - Country:US
Mailing Address - Phone:208-946-8044
Mailing Address - Fax:855-610-2310
Practice Address - Street 1:1309 PONDEROSA DR STE 203
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-8278
Practice Address - Country:US
Practice Address - Phone:208-946-8044
Practice Address - Fax:855-610-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty