Organization · Type 2 NPI

State of Idaho

Psychologist · Blackfoot, ID

NPI number 1053615260 Active

Practice location

700 E Alice St
Blackfoot, ID 83221-4925

Call (208) 785-8506 Map

Fax (208) 785-8518

Specialties and licenses

TaxonomyCodeLicense
Psychologist Primary 103T00000X17 (ID)

Psychologist: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustmen…

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About NPI 1053615260

State of Idaho's National Provider Identifier is 1053615260, issued on Jan 3, 2011. The primary taxonomy on file is Psychologist (103T00000X), and the practice location is in Blackfoot, ID. The record was last updated on Jan 3, 2011.