Provider Demographics
NPI:1427734524
Name:AVANTI MENTAL HEALTH INC
Entity type:Organization
Organization Name:AVANTI MENTAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-534-5447
Mailing Address - Street 1:1323 AMMON PARK DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4591
Mailing Address - Country:US
Mailing Address - Phone:208-534-5447
Mailing Address - Fax:309-534-5507
Practice Address - Street 1:1323 AMMON PARK DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4591
Practice Address - Country:US
Practice Address - Phone:208-534-5447
Practice Address - Fax:309-534-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty