Healthcare Provider Details

I. General information

NPI: 1083636914
Provider Name (Legal Business Name): ANALYTIC ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 W HAYS STREET
BOISE ID
83702-5028
US

IV. Provider business mailing address

1408 W HAYS STREET
BOISE ID
83702-5028
US

V. Phone/Fax

Practice location:
  • Phone: 208-385-9200
  • Fax: 208-336-7125
Mailing address:
  • Phone: 208-385-9200
  • Fax: 208-336-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberLCSW1219
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberLCSW1219
License Number StateID

VIII. Authorized Official

Name: MR. STANLEY A. ZUCKERMAN
Title or Position: PSYCHOTHERAPIST
Credential: MSW
Phone: 208-385-9200