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General NPI Number Information
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NPI Number | 1922129840
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSESSMENT SPECIALISTS
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 12/08/2024
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Provider Practice Location Address
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Address Line | 1246 YELLOWSTONE AVE STE C5
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City | POCATELLO
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State | ID
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Zip | 83201-4373
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Country | US
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Telephone | 208-233-0150
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Fax | 208-233-0159
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Provider Business Mailing Address
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Address Line | 1246 YELLOWSTONE AVE STE C5
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City | POCATELLO
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State | ID
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Zip | 83201-4373
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Country | US
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Telephone | 208-233-0150
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Fax | 208-233-0159
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | JOHN L. CHRISTENSEN
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Credential | PHD
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Telephone | 208-233-0150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | ID
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