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General NPI Number Information
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NPI Number | 1750257184
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Entity Type | Organization
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Legal Business Name | IDAHO NEUROPSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1305 S FIVE MILE RD
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City | BOISE
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State | ID
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Zip | 83709-1306
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Country | US
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Telephone | 208-789-0910
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Fax | 208-789-0916
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Provider Business Mailing Address
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Address Line | 10400 W OVERLAND RD # 357
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City | BOISE
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State | ID
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Zip | 83709-1433
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Country | US
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Telephone | 208-789-0910
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Fax | 208-789-0916
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JOSEPH S BLACK
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Credential | PHD, ABN
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Telephone | 208-207-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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