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General NPI Number Information
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NPI Number | 1861759854
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Entity Type | Organization
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Legal Business Name | EPIC PSYCHOLOGICAL SERVICES, PLLC
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 2273 E GALA ST SUITE 100
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City | MERIDIAN
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State | ID
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Zip | 83642-7289
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Country | US
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Telephone | 208-898-8999
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Fax | 208-898-8989
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Provider Business Mailing Address
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Address Line | 24108 TEN DAVIS RD
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City | PARMA
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State | ID
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Zip | 83660-7212
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Country | US
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Telephone | 208-898-8999
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Fax | 208-898-8989
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN J HULBERT
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Credential | PH.D.
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Telephone | 208-898-8999
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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-282
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY-282
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-282
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License Number State | ID
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