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General NPI Number Information
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NPI Number | 1518102797
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Entity Type | Organization
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Legal Business Name | NORTHWEST NEUROBEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 6003 OVERLAND RD STE 301
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City | BOISE
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State | ID
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Zip | 83709-3077
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Country | US
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Telephone | 208-672-8699
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Fax | 208-672-9308
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Provider Business Mailing Address
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Address Line | 6003 OVERLAND RD STE 301
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City | BOISE
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State | ID
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Zip | 83709-3077
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Country | US
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Telephone | 208-672-8699
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Fax | 208-672-9308
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TREVOR ALLEN HALL
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Credential | PSYD
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Telephone | 208-672-8699
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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 | PSY202444
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License Number State | ID
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