Healthcare Provider Details

I. General information

NPI: 1073996401
Provider Name (Legal Business Name): ERIKA LEIGH EISELE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST CRH # 444, 2ND FLOOR
BOISE ID
83702-4501
US

IV. Provider business mailing address

1200 N MAIN ST UNIT 1223
MERIDIAN ID
83680-5054
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1018
  • Fax:
Mailing address:
  • Phone: 208-908-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: