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General NPI Number Information
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NPI Number | 1487514212
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Entity Type | Organization
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Legal Business Name | THE UNDISCOVERED SELF, PC
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Dates
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Enumeration Date | 11/14/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 1015 W HAYS ST STE 205
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City | BOISE
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State | ID
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Zip | 83702-5412
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Country | US
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Telephone | 310-500-6862
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 E WARM SPRINGS AVE
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City | BOISE
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State | ID
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Zip | 83712-8025
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Country | US
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Telephone | 310-500-6862
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOHN ANTHONY BERADINO
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Credential | PHD
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Telephone | 310-500-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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