NPI age
15 years
Enumerated 2011-05-06
Across 38 active psychologist providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 46-1124545 | TAX ID |
| 05 (ID) | 1710279807 | |
| 01 (ID) | 12239758 | CAQH |
Part of a multi-provider practice. 9 other active providers share this practice address in NPPES.
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