Nicholas E. Heyneman, PHD
Individual provider Active NPI Clinical Psychologist · Pocatello, ID
NPI 1043370372 · NPPES record last updated Feb 3, 2014
Key facts
- NPI
- 1043370372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY-234 (ID)
- Practice address
- 850 E Center St
Suite a
Pocatello, ID 83201-5737 - Phone
- (208) 234-7740
- Fax
- (208) 392-1541
- NPI assigned
- Dec 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-234 | ID | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-234 | ID | Yes |
Addresses
Primary practice location
850 E Center St
Suite a
Pocatello, ID 83201-5737
Mailing address
24 Yale St
Pocatello, ID 83201-3436
Phone (208) 234-7740
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010017340 | Other | ID | REGENCE BLUE SHIELD |
| N-2340 | Other | ID | BLUE CROSS |
Other providers in Pocatello, ID
- Heritage Home Health, LLC
- Heritage Physician and Resource Group LLC
- Daniel Herrera
- Jessica Beth Hetcko
- Jonah Nicholas Heyneman
- Monte Cache Hibbert
- Logan D Higbee
- Shawn R Higbee
- Justin Higgins
- Highland Physical Therapy LLC
All providers in Pocatello, ID · Clinical Psychologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.