Provider Demographics
NPI:1134241144
Name:ALA, LLC
Entity type:Organization
Organization Name:ALA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-234-2094
Mailing Address - Street 1:818 E LANDER ST.
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:208-234-2094
Mailing Address - Fax:208-234-2637
Practice Address - Street 1:818 E LANDER ST.
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-234-2094
Practice Address - Fax:208-234-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8040465Medicaid