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General NPI Number Information
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NPI Number | 1750273827
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Entity Type | Individual
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Provider Name | HEATH RICHARD IVERS BCBA
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Gender | Male
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 2222 TETON PLZ STE 2
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6485
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Country | US
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Telephone | 208-522-4026
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Fax | 208-522-4138
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Provider Business Mailing Address
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Address Line | 500 S 11TH AVE STE 504
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City | POCATELLO
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State | ID
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Zip | 83201-4881
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Country | US
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Telephone | 208-478-9344
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Fax | 208-478-9368
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BCBA12578953
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License Number State |
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