Panhandle Behavioal Health

Primary specialty

Rehabilitation PsychologistTaxonomy code 103TR0400X

Legal business name

PANHANDLE BEHAVIOAL HEALTH

Practice address

212 S 11TH St
Suite 5
Coeur D Alene, ID 83814-4000

Phone

(208) 755-6121

Fax

(208) 667-2681

NPI assigned

Mar 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack Elmo Wright, PH.D.

Title

Owner

Phone

(406) 745-0148

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Panhandle Horizons Doing business as

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

{
    "created_epoch": "1173484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218067200000",
    "number": "1851423446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32126 ALLISON RD",
            "city": "ST IGNATIUS",
            "state": "MT",
            "postal_code": "598659155",
            "telephone_number": "406-745-0148",
            "fax_number": "208-667-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S 11TH ST",
            "address_2": "SUITE 5",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144000",
            "telephone_number": "208-755-6121",
            "fax_number": "208-667-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANHANDLE BEHAVIOAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-10",
        "last_updated": "2008-08-07",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "ELMO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "406-745-0148",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806144500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGY LICENSE",
            "identifier": "PSY90",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panhandle Horizons",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela Marie Palmer, CADC
• John Ryan Palmer, LMSW
• Matthew David Palmer, NP
• Elise Lynn Palus
• Angela Pana, MD
• Amanda Michele Pankratz
• Craig James Panos, M. D.
• Erica Lynn Panttaja, APRN
• Patrick John Parden, M.D.
• Jamie Lee Park, PHARM.D.

• Rehabilitation Psychologist in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Rehabilitation Psychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; 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.