| Big Lake Psychological Services, Pc | |
|
1809 E Sherman Ave Coeur D Alene ID 83814-5873 | |
| (208) 665-9611 | |
| Not Available |
| Full Name | Big Lake Psychological Services, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 1809 E Sherman Ave, Coeur D Alene, Idaho |
| Authorized Official Name and Position | Heather Rehil (CHIEF PSYCHOLOGIST) |
| Authorized Official Contact | 2085503165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Big Lake Psychological Services, Pc 1104 W Ironwood Dr Coeur D Alene ID 83814-2605 Ph: (208) 550-3165 | Big Lake Psychological Services, Pc 1809 E Sherman Ave Coeur D Alene ID 83814-5873 Ph: (208) 665-9611 |
| NPI Number | 1508100876 |
|---|---|
| Provider Enumeration Date | 11/26/2012 |
| Last Update Date | 07/27/2020 |
| Certification Date | 07/27/2020 |
| Medicare PECOS PAC ID | 3678999182 |
|---|---|
| Medicare Enrollment ID | O20200814000491 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508100876 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC2200X | Psychologist - Clinical Child & Adolescent | PSY-202671 (Idaho) | Primary |
| Provider Name | Perry E Grey Harper |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1528248333 PECOS PAC ID: 6305971854 Enrollment ID: I20210209001636 |
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