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General NPI Number Information
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NPI Number | 1104083724
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Entity Type | Organization
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Legal Business Name | CALDWELL PSYCHOLOGICAL SERVICES P.A.
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 815 FILLMORE
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City | CALDWELL
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State | ID
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Zip | 83605-4173
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Country | US
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Telephone | 208-459-6962
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Fax | 208-459-4476
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Provider Business Mailing Address
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Address Line | 815 FILLMORE
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City | CALDWELL
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State | ID
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Zip | 83605-4173
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Country | US
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Telephone | 208-459-6962
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Fax | 208-459-4476
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | PHARES LINDEMAN BOOK
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Credential | PSY.D.
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Telephone | 208-459-6962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 202193
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License Number State | ID
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