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General NPI Number Information
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NPI Number | 1053679985
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Entity Type | Individual
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Provider Name | MICHAEL BRINKER PSYD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2012
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Last Update Date | 08/15/2017
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Provider Practice Location Address
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Address Line | 2076 S EAGLE RD
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City | MERIDIAN
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State | ID
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Zip | 83642-6707
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Country | US
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Telephone | 289-775-4515
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Fax |
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Provider Business Mailing Address
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Address Line | 711 WEST VILLAGE LANE
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City | BOISE
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State | ID
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Zip | 83702
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Country | US
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Telephone | 303-681-8712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 202751
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License Number State | ID
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