Healthcare Provider Details

I. General information

NPI: 1295328045
Provider Name (Legal Business Name): NEXT LEVEL PSYCHIATRY IDAHO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE R
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

2831 SAINT ROSE PKWY STE 221
HENDERSON NV
89052-4840
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-4871
  • Fax:
Mailing address:
  • Phone: 702-589-4871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM TREESE
Title or Position: PRESIDENT
Credential:
Phone: 702-589-4871