Healthcare Provider Details

I. General information

NPI: 1700889466
Provider Name (Legal Business Name): A JOSEPH SALAIS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 W OVERLAND RD #214
BOISE ID
83709-1433
US

IV. Provider business mailing address

10400 W OVERLAND RD #214
BOISE ID
83709-1433
US

V. Phone/Fax

Practice location:
  • Phone: 925-942-7110
  • Fax: 208-297-6551
Mailing address:
  • Phone: 925-942-7110
  • Fax: 208-297-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: