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General NPI Number Information
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NPI Number | 1619001005
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Entity Type | Individual
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Provider Name | ALLISON LEE ETNYRE PSY.D
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Gender | Female
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 1070 N CURTIS RD SUITE 210
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City | BOISE
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State | ID
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Zip | 83706-1238
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Country | US
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Telephone | 208-860-0770
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Fax | 208-322-0367
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Provider Business Mailing Address
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Address Line | 11368 W HICKORY BARK DR
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City | BOISE
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State | ID
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Zip | 83713-1004
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Country | US
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Telephone | 208-323-9698
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PSY-202238
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License Number State | ID
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