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NEXGEN MENTAL HEALTH & WELLNESS

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Company Details

Name: NEXGEN MENTAL HEALTH & WELLNESS
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 29 May 2018 (7 years ago)
Entity Number: 612103
Place of Formation: IDAHO
File Number: 0000612103
ZIP code: 83706
County: Ada County
Mailing Address: 3152 S BOWN WAY SUITE 101 BOISE, ID 83706

National Provider Identifier

NPI Number:
1801376066

Authorized Person:

Name:
DONNA J CHRISTENSEN
Role:
MANAGING MEMBER
Phone:

Taxonomy:

Selected Taxonomy:
363LF0000X - Family Nurse Practitioner
Is Primary:
No
Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
2085766930

Filing

Filing Name Filing Number Filing date
Initial Filing 0000612103 2018-05-29

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State