NPIMap

Organization Active NPI

Physicians Mental Health Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Pocatello, ID
National Provider Identifier
1194063750
Registry record updated Apr 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
0314 Issued in ID
Legal business name
PHYSICIANS MENTAL HEALTH SERVICES
Practice address
475 Yellowstone Ave
Suite E
Pocatello, ID 83201-4528
Phone
(208) 478-7422
Fax
(208) 478-1515
NPI assigned
Jan 16, 2013
Last updated
Apr 25, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANCED HEALTHCARE SOLUTIONS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Matthew Andersen, LPCNPI 1932449519
Title
Director
Phone
(208) 232-0021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 0314 ID Primary

Addresses

Primary practice location

475 Yellowstone Ave
Suite E
Pocatello, ID 83201-4528

Mailing address

1110 Call Creek Dr
Suite 7
Pocatello, ID 83201-3001
Phone (208) 232-0021

National Provider Directory

National Provider Directory
Part of
Advanced Healthcare

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1194063750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 CALL CREEK DR",
            "address_2": "SUITE 7",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013001",
            "telephone_number": "208-232-0021",
            "fax_number": "208-232-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 YELLOWSTONE AVE",
            "address_2": "SUITE E",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014528",
            "telephone_number": "208-478-7422",
            "fax_number": "208-478-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS MENTAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED HEALTHCARE SOLUTIONS, LLC",
        "enumeration_date": "2013-01-16",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "ANDERSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "208-232-0021",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "ID",
            "license": "0314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.