Psychology Center of Idaho Falls

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

202288 Issued in ID

Legal business name

PSYCHOLOGY CENTER OF IDAHO FALLS

Practice address

3670 S 25TH E Ste 2
Idaho Falls, ID 83404-4956

Phone

(208) 522-3404

Fax

(208) 524-1093

NPI assigned

Sep 18, 2013

Last updated

Sep 18, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carol Vernon Anderson, PH.D. ABPP-CNNPI 1396878401

Title

President, Cliical Neuropsychologis

Phone

(208) 522-3404

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol V Anderson, PHD

  • Clinical Psychologist
  • Idaho Falls, ID
  • NPI 1396878401
  Medicare reassignment NPD Authorized official
• Douglas E. Craig, PHD

  • Psychologist
  • Idaho Falls, ID
  • NPI 1336378447
  NPD (past)
• Aaron A Harris, PHD

  • Clinical Psychologist
  • Idaho Falls, ID
  • NPI 1669480091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1379462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1780010090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 S 25TH E STE 2",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044956",
            "telephone_number": "208-522-3404",
            "fax_number": "208-524-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 S 25TH E STE 2",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044956",
            "telephone_number": "208-522-3404",
            "fax_number": "208-524-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHOLOGY CENTER OF IDAHO FALLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-18",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "PRESIDENT, CLIICAL NEUROPSYCHOLOGIS",
        "authorized_official_telephone_number": "208-522-3404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D. ABPP-CN"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "ID",
            "license": "202288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pro Heal Hyperbarics & Wound Care
• Progress Therapy LLC
• Proventures LLC (Side by Side Family Services)
• Psychological Preventative Health PLLC
• Psychological Service Associates
• PT Medical LLC
• Katherine Ann Puckett, BS, SIT
• Zachary Lynn Pugmire, DPT
• Gary Kevin Pullen, RPH
• Catherine Ann Purser, NP

• Clinical Neuropsychologist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Clinical Neuropsychologist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.