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General NPI Number Information
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NPI Number | 1831131945
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Entity Type | Individual
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Provider Name | JUDY N LAM PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 01/21/2021
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Provider Practice Location Address
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Address Line | 2409 N 21ST ST
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City | BOISE
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State | ID
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Zip | 83702-0508
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Country | US
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Telephone | 208-283-0628
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Fax | 208-209-2388
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Provider Business Mailing Address
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Address Line | 2409 N 21ST ST
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City | BOISE
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State | ID
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Zip | 83702-0508
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Country | US
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Telephone | 208-283-0628
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Fax | 208-209-2388
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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 16908
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 202366
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License Number State | ID
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