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General NPI Number Information
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NPI Number | 1942090865
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Entity Type | Organization
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Legal Business Name | ALPINE RIDGE PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1464 N 805 E
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City | SHELLEY
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State | ID
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Zip | 83274-5049
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Country | US
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Telephone | 208-728-7750
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Fax | 208-728-7750
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Provider Business Mailing Address
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Address Line | 2184 CHANNING WAY # 119
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8034
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Country | US
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Telephone | 208-728-7750
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Fax | 208-728-7750
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. MICHAEL ROBERT THOMAS
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Credential | PHD
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Telephone | 208-728-7750
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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 |
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License Number State |
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