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General NPI Number Information
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NPI Number | 1851912117
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Entity Type | Organization
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Legal Business Name | HIGH DESERT PSYCHIATRY LLC
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Dates
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Enumeration Date | 04/28/2020
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Last Update Date | 04/28/2020
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Provider Practice Location Address
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Address Line | 4477 W EMERALD ST STE C275
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City | BOISE
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State | ID
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Zip | 83706-2078
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Country | US
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Telephone | 208-315-6444
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 W STATE ST STE 123
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City | BOISE
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State | ID
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Zip | 83702-3924
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Country | US
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Telephone | 208-615-6444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WARREN GRANT HARBISON
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Credential | MD
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Telephone | 208-315-6444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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