| Organization Name: | SALMON MENTAL HEALTH CLINIC PA |
| NPI Number: | 1407870900 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAMELA J BAGLIEN (CO OWNER CHAIRMAN) |
| Mailing Address: | 111 Lillian St Suite 101 Salmon |
| State: | ID US |
| Postal Code: | 834674301 |
| Phone Number: | 2087561573 |
| Fax Number: | 2087561579 |
| NPI Enumeration Date: | 07/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |