STATE OF IDAHO

Psychologist

Active Organization
NPI: 1053615260

Practice Address

700 E ALICE ST
Blackfoot, ID 83221

Phone: (208) 785-8506

Specialties

Specialty Code Primary License
Psychologist 103T00000X Yes 17 (ID)

Frequently Asked Questions

NPI 1053615260 is the National Provider Identifier for STATE OF IDAHO, a Psychologist provider located in Blackfoot, ID. This NPI was enumerated on January 3, 2011.

Quick Facts

NPI
1053615260
Type
Organization
Enumerated
Jan 3, 2011
Last Updated
Jan 3, 2011

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