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General NPI Number Information
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NPI Number | 1447888656
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Entity Type | Organization
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Legal Business Name | BERNDT AND ASSOCIATES IN PSYCHCARE LLC
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Dates
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Enumeration Date | 04/01/2020
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 4477 W EMERALD ST STE C275
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City | BOISE
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State | ID
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Zip | 83706-2078
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Country | US
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Telephone | 208-268-8858
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Fax | 208-408-0694
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Provider Business Mailing Address
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Address Line | 4477 W EMERALD ST STE C275
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City | BOISE
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State | ID
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Zip | 83706-2078
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Country | US
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Telephone | 208-268-8858
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Fax | 208-408-0694
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Authorized Official
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Title or Position | OWNER
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Name | CAROLL BERNDT
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Credential | PSYD
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Telephone | 208-268-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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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 |
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License Number State |
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