STATE OF IDAHO
Organization (NPI-2)
Active
Psychologist
Provider Information
- NPI Number
1053615260- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 700 E ALICE ST, BLACKFOOT, ID, 832214925
- Phone
- (208) 785-8506
- Fax
- (208) 785-8518
Specialties & Taxonomies
Psychologist
Primary License: ID #17