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General NPI Number Information
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NPI Number | 1336333152
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 1070 N CURTIS RD SUITE 210
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City | BOISE
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State | ID
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Zip | 83706-1238
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Country | US
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Telephone | 208-906-2007
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Fax |
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Provider Business Mailing Address
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Address Line | 1070 N CURTIS RD SUITE 210
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City | BOISE
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State | ID
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Zip | 83706-1238
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Country | US
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Telephone | 208-906-2007
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. ALLISON ETNYRE
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Credential | PSY.D.
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Telephone | 208-906-2007
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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 | PSY-323
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-202238
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License Number State | ID
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