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General NPI Number Information
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NPI Number | 1275705410
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Entity Type | Organization
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Legal Business Name | BRENT F. BALDREE PH.D., INC.
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 2539 CHANNING WAY SUITE 260
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7544
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Country | US
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Telephone | 208-552-3050
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Fax |
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Provider Business Mailing Address
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Address Line | 2539 CHANNING WAY SUITE 260
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7544
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Country | US
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Telephone | 208-552-3050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENT F BALDREE
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Credential | PH.D.
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Telephone | 208-552-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | PSY377
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License Number State | ID
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