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General NPI Number Information
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NPI Number | 1437452828
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CONSULTANTS, PC
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 100 N 1ST AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1376
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Country | US
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Telephone | 208-263-2040
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N 1ST AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1376
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Country | US
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Telephone | 208-263-2040
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. GLORIA J WATERHOUSE
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Credential | PHD
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Telephone | 208-263-2040
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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-202071
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License Number State | ID
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