Idaho Dept of Health & Welfare Amhcalpgreg3
Organization Active NPI Prescribing (Medical) Psychologist · Caldwell, ID
NPI 1104004928 · NPPES record last updated Jan 28, 2009
Key facts
- NPI
- 1104004928
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Prescribing (Medical) Psychologist 103TP0016X
- Legal business name
- IDAHO DEPT OF HEALTH & WELFARE AMHCALPGREG3
- Practice address
- 3402 Franklin Rd
Caldwell, ID 83605-6932 - Phone
- (208) 459-0092
- Fax
- (208) 454-7714
- NPI assigned
- Feb 4, 2008
- Organization subpart
- No
Authorized official
- Name
- Todd L Hurt, MS
- Title
- Field Operations Manager
- Phone
- (208) 455-7057
Corporate family (same tax ID) 21
National Provider Directory
- Tax ID family
- Reg VI Mental Health Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prescribing (Medical) Psychologist |
103TP0016X | Yes |
Addresses
Primary practice location
3402 Franklin Rd
Caldwell, ID 83605-6932
Mailing address
3402 Franklin Rd
Caldwell, ID 83605-6932
Phone (208) 459-0092
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HW298 | Other | BLUE CROSS OF IDAHO | |
| 8076191 | Medicaid | ID | |
| 000010027633 | Other | ID | BLUESHIELD |
Other providers in Caldwell, ID
- Ashley R Hust
- Sausha Nichole Hyatt
- Icare Virtual Urgent Care
- Idaho Behavioral Health, Inc.
- Idaho Department of Health & Welfare
- Idaho Dhwbh3 Caldamhclinic
- Idaho Diagnostic Sleep Lab, Inc.
- Idaho Emergency Medical Group PC
- Idaho Sleep and Neurology PLLC
- Idaho Sleep and Neurology, PLLC
All providers in Caldwell, ID · Prescribing (Medical) 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 Jan 28, 2009. 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.