NPI age
19 years
Enumerated 2006-07-17
Across 196 active psychologist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002648300 | |
| 01 (ID) | N6168 | BLUE CROSS |
| 01 (ID) | 820428306 | TRICARE |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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