Citadel Mental Health LLC
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Meridian, ID
NPI 1831936848 · NPPES record last updated Jul 9, 2024
Key facts
- NPI
- 1831936848
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- CITADEL MENTAL HEALTH LLC
- Practice address
- 1833 S Millenium Way Ste 100
Meridian, ID 83642-1510 - Phone
- (208) 614-3637
- NPI assigned
- Jul 9, 2024
- Organization subpart
- No
Authorized official
- Name
- Verlyn Glenn, AP
- Title
- Owner
- Phone
- (509) 828-8307
Practitioners 1
-
Verlyn Glenn, PMHNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240924001289 | ID | Part B Supplier - Clinic/Group Practice | 1153862685 |
Receives reassigned benefits from 1 practitioner Practice locations: Meridian, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
1833 S Millenium Way Ste 100
Meridian, ID 83642-1510
Mailing address
1711 W Wood Chip St
Meridian, ID 83642-7322
Phone (509) 828-8307
Other names
- Citadel Integrative Psychiatry
Other providers in Meridian, ID
- Sunny Chuang
- Sung Jae Chung
- Raegan Darlene Church
- Tausalaanna Toagamau Church
- Samantha Paige Cimino
- Cynthia Rae Clapper
- Zachary Clare
- Bailee Ann Clark
- Clinton H Clark
- Jeremiah Robins Clark
All providers in Meridian, ID · Mental Health Clinic/Center (Including Community Mental Health Center) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.