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General NPI Number Information
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NPI Number | 1528136793
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES, PA
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 493 EASTLAND DR
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City | TWIN FALLS
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State | ID
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Zip | 83301-7480
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Country | US
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Telephone | 208-732-0995
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Fax | 208-732-0993
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | TWIN FALLS
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State | ID
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Zip | 83303-0047
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Country | US
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Telephone | 208-732-0995
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Fax | 208-732-0993
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JULIE JOHANSEN
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Credential |
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Telephone | 208-732-0995
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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 | M5371
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | LMFT-2687
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | LPC3381
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | PA499
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | LCPC3433
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License Number State | ID
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Taxonomy #6
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | CNS12
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License Number State | ID
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | LCPC3404
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License Number State | ID
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