Provider Demographics
NPI:1700118999
Name:MONARCH MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:MONARCH MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MADREE
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-676-1075
Mailing Address - Street 1:2115 E. SHERMAN AVE #104
Mailing Address - Street 2:
Mailing Address - City:COEUR D 'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-676-1075
Mailing Address - Fax:208-676-1245
Practice Address - Street 1:2115 E. SHERMAN AVE #104
Practice Address - Street 2:
Practice Address - City:COEUR D 'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-676-1075
Practice Address - Fax:208-676-1245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-29101251B00000X, 251S00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807335700Medicaid
ID807342300Medicaid
ID807652000Medicaid