Active NPI
Daniel Edward Timberlake, PHD
- Psychologist
- Boise, ID
National Provider Identifier
1881980357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY-202436
- Practice address
- 1910 University Dr
Ms 1351
Boise, ID 83725-1351 - Phone
- (208) 426-1459
- NPI assigned
- Jun 23, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY-202436 | ID | Primary |
Addresses
Primary practice location
1910 University Dr
Ms 1351
Boise, ID 83725-1351
Mailing address
5840 S Horseshoe PL
Boise, ID 83716
Phone (208) 608-6484
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202436 | ID | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boise State Health Center | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Boise State University
- Student Health Clinic/Center
- Boise, ID
- NPI 1194865444
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308787200000",
"number": "1881980357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5840 S HORSESHOE PL",
"city": "BOISE",
"state": "ID",
"postal_code": "83716",
"telephone_number": "208-608-6484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 UNIVERSITY DR",
"address_2": "MS 1351",
"city": "BOISE",
"state": "ID",
"postal_code": "837251351",
"telephone_number": "208-426-1459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIMBERLAKE",
"first_name": "DANIEL",
"middle_name": "EDWARD",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-23",
"last_updated": "2011-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "ID",
"license": "PSY-202436",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.