Provider Demographics
NPI:1104214618
Name:PERMA MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:PERMA MENTAL HEALTH PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-996-1700
Mailing Address - Street 1:950 W BANNOCK ST STE 1100
Mailing Address - Street 2:STE. 1100
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6140
Mailing Address - Country:US
Mailing Address - Phone:208-996-1700
Mailing Address - Fax:855-593-7090
Practice Address - Street 1:950 W BANNOCK ST STE 1100
Practice Address - Street 2:STE. 1100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6140
Practice Address - Country:US
Practice Address - Phone:208-996-1700
Practice Address - Fax:855-593-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMD 125002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20005246Medicare PIN