Provider Demographics
NPI:1215432539
Name:BELLA-NACOLE MENTAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BELLA-NACOLE MENTAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-226-4943
Mailing Address - Street 1:850 E YOUNG ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5736
Mailing Address - Country:US
Mailing Address - Phone:208-220-8606
Mailing Address - Fax:208-242-3892
Practice Address - Street 1:808 N 8TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5718
Practice Address - Country:US
Practice Address - Phone:208-226-4943
Practice Address - Fax:208-242-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health