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General NPI Number Information
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NPI Number | 1689868937
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Entity Type | Individual
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Provider Name | CHARLES R KAUFMAN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 464 SHOUP AVE W BOX 5591
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City | TWIN FALLS
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State | ID
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Zip | 83301-5045
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Country | US
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Telephone | 208-734-8844
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Fax | 208-734-8844
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Provider Business Mailing Address
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Address Line | 464 SHOUP AVE W BOX 5591
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City | TWIN FALLS
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State | ID
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Zip | 83301-5045
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Country | US
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Telephone | 208-734-8844
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Fax | 208-734-8844
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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 | PSY149
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License Number State | ID
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