IDAHO DEPT OF HEALTH & WELFARE AMHCALPGREG3 NPI 1104004928

NPI Information

IDAHO DEPT OF HEALTH & WELFARE AMHCALPGREG3 is a prescribing (medical) psychologist in Caldwell, ID. The provider is a licensed, doctoral-level psychologist authorized to prescribe and has undergone specialized education and training in preparation for prescriptive practice and has passed an examination accepted by the state board of psychology relevant to establishing competence for prescribing, and has received from the state board of psychology a current certificate granting prescriptive authority, which has not been revoked or suspended. IDAHO DEPT OF HEALTH & WELFARE AMHCALPGREG3 NPI is 1104004928. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3402 FRANKLIN RD
CALDWELL, ID
ZIP 83605-932
Phone: (208) 459-0092
Fax: (208) 454-7714

The provider's authorized official is Todd L Hurt .
The authorized official title is Field Operations Manager and has the following contact phone number (208) 455-7057.

The enumeration date for this NPI number is 2/4/2008 and was last updated on 1/28/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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