Montera Health Idaho LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

MONTERA HEALTH IDAHO LLC

Practice address

784 S Clearwater Loop Ste R
Post Falls, ID 83854-9599

Phone

(865) 680-1516

NPI assigned

Mar 3, 2022

Organization subpart

No

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

Authorized official

Name

Qingqing Mao

Title

Admin

Phone

(415) 805-1725

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1619624202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8059 W. PREECE DRIVE #1078",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83704",
            "telephone_number": "865-680-1516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 S CLEARWATER LOOP STE R",
            "city": "POST FALLS",
            "state": "ID",
            "postal_code": "838549599",
            "telephone_number": "865-680-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTERA HEALTH IDAHO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2024-01-31",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "MAO",
        "authorized_official_first_name": "QINGQING",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "415-805-1725"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Post Falls, ID
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.