Healthcare Provider Details

I. General information

NPI: 1447888656
Provider Name (Legal Business Name): BERNDT AND ASSOCIATES IN PSYCHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 W EMERALD ST STE C275
BOISE ID
83706-2078
US

IV. Provider business mailing address

4477 W EMERALD ST STE C275
BOISE ID
83706-2078
US

V. Phone/Fax

Practice location:
  • Phone: 208-268-8858
  • Fax: 208-408-0694
Mailing address:
  • Phone: 208-268-8858
  • Fax: 208-408-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CAROLL BERNDT
Title or Position: OWNER
Credential: PSYD
Phone: 208-268-8858