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NPI Code Detail

MEDICARE: LAUREN CHAVIS PSYD

MEDICARE: LAUREN CHAVIS PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY-203813ID

General Provider Information

NPI Number : 1588909931
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN CHAVIS PSYD
Provider Business Mailing Address
First Line : 1065 E WINDING CREEK DR STE 250
Second Line :
City : EAGLE
State : ID
Zip : 83616-7246
Country : US
Telephone Number : 208-423-8375
Fax Number :
Provider Business Practice Location Address
First Line : 1065 E WINDING CREEK DR STE 250
Second Line :
City : EAGLE
State : ID
Zip : 83616-7246
Country : US
Telephone Number : 208-423-8375
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2012
Last Update Date : 03/01/2025

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