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General NPI Number Information
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NPI Number | 1447113980
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Entity Type | Organization
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Legal Business Name | STRAIGHT EDGE PSYCHIATRY PLLC
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 413 N ALLUMBAUGH ST STE 101
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City | BOISE
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State | ID
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Zip | 83704-9219
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Country | US
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Telephone | 208-451-5413
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190703
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City | BOISE
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State | ID
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Zip | 83719-0703
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Country | US
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Telephone | 208-451-5413
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. MERRILL VELEZ
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Credential | MD
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Telephone | 208-451-5413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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