Provider Demographics
NPI:1750621116
Name:NEW HORIZONS MENTAL WELLNESS CLINICS
Entity type:Organization
Organization Name:NEW HORIZONS MENTAL WELLNESS CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARRIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:208-380-0194
Mailing Address - Street 1:PO BOX 4789
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4789
Mailing Address - Country:US
Mailing Address - Phone:208-380-0194
Mailing Address - Fax:208-233-2178
Practice Address - Street 1:1352 E. CENTER
Practice Address - Street 2:SUITE A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4773
Practice Address - Country:US
Practice Address - Phone:208-380-0194
Practice Address - Fax:208-233-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP1034A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health