Healthcare Provider Details

I. General information

NPI: 1568388965
Provider Name (Legal Business Name): JOSEPH THIEN DO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSEPH THIEN PHAM LPC

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W BURNSIDE AVE
CHUBBUCK ID
83202-4916
US

IV. Provider business mailing address

444 N 12TH AVE
POCATELLO ID
83201-4715
US

V. Phone/Fax

Practice location:
  • Phone: 208-238-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number7981910
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: