NPI age
19 years
Enumerated 2006-05-30
Across 235 active psychologist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010149290 | REGENCE BLUE SHIELD PIN |
| 01 (WA) | 380-319 | DSHS PROVIDER NUMBER |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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