Organization Name: | NORTHWEST NEUROBEHAVIORAL HEALTH, LLC |
NPI Number: | 1013223445 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER A LA JEUNESSE (CO-OWNER) |
Mailing Address: | 2076 S Eagle Rd Meridian |
State: | ID US |
Postal Code: | 836426707 |
Phone Number: | 2089557333 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2010 |
NPI Last Update Date: | 08/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY-202425 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |