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General NPI Number Information
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NPI Number | 1972992063
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Entity Type | Individual
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Provider Name | KRISTINE MCCORMICK PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 600 N ROBBINS RD STE 100
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City | BOISE
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State | ID
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Zip | 83702-4539
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Country | US
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Telephone | 208-381-9037
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Fax | 208-385-3616
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1071556
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License Number State | ID
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