Healthcare Provider Details

I. General information

NPI: 1346229432
Provider Name (Legal Business Name): YVETTE L. WARD PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOPE DR BLDG #6000
MOUNTAIN HOME A F B ID
83648-1057
US

IV. Provider business mailing address

1414 W FRANKLIN ST
BOISE ID
83702-5023
US

V. Phone/Fax

Practice location:
  • Phone: 208-828-7580
  • Fax: 208-828-7520
Mailing address:
  • Phone: 208-343-0647
  • Fax: 208-395-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-412
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: