| Idaho Institute Of Gender And Sex Therapy | |
|
6003 W Overland Rd Ste 105 Boise ID 83709-3075 | |
| (208) 417-8428 | |
| (208) 216-1434 |
| Full Name | Idaho Institute Of Gender And Sex Therapy |
|---|---|
| Speciality | Social Worker |
| Location | 6003 W Overland Rd Ste 105, Boise, Idaho |
| Authorized Official Name and Position | Jeremy Wayne Irvin (OWNER) |
| Authorized Official Contact | 2084178428 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Institute Of Gender And Sex Therapy 3278 E Renwick St Meridian ID 83642-6467 Ph: (208) 417-8428 | Idaho Institute Of Gender And Sex Therapy 6003 W Overland Rd Ste 105 Boise ID 83709-3075 Ph: (208) 417-8428 |
| NPI Number | 1811451438 |
|---|---|
| Provider Enumeration Date | 01/28/2019 |
| Last Update Date | 12/10/2021 |
| Certification Date | 12/10/2021 |
| Medicare PECOS PAC ID | 8628408879 |
|---|---|
| Medicare Enrollment ID | O20200430002411 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811451438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jeremy Wayne Irvin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245684927 PECOS PAC ID: 1355638545 Enrollment ID: I20161003002501 |
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