Healthcare Provider Details

I. General information

NPI: 1790866366
Provider Name (Legal Business Name): LISA A. DAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/17/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 1ST ST W
KETCHUM ID
83340-0100
US

IV. Provider business mailing address

PO BOX 4975
HAILEY ID
83333-4975
US

V. Phone/Fax

Practice location:
  • Phone: 208-720-9342
  • Fax: 208-726-6467
Mailing address:
  • Phone: 208-720-9342
  • Fax: 208-726-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY202748
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: