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General NPI Number Information
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NPI Number | 1871672840
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICE ASSOCIATES
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 2235 E 25TH ST SUITE 290
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7519
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Country | US
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Telephone | 208-525-2090
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Fax | 208-525-2662
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Provider Business Mailing Address
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Address Line | PO BOX 3480
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3480
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Country | US
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Telephone | 208-525-2090
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Fax | 208-525-2662
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Authorized Official
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Title or Position | OWNER
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Name | HOWARD K HARPER
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Credential | PHD
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Telephone | 208-552-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT-2661
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License Number State | ID
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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-386
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License Number State | ID
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