| Modern Psychotherapy Services | |
|
4875 W Athens Ct Eagle ID 83616-5138 | |
| (208) 731-7646 | |
| Not Available |
| Full Name | Modern Psychotherapy Services |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4875 W Athens Ct, Eagle, Idaho |
| Authorized Official Name and Position | Diana Lincoln-haye (PRESIDENT) |
| Authorized Official Contact | 2087317646 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Psychotherapy Services 4875 W Athens Ct Eagle ID 83616-5138 Ph: (208) 731-7646 | Modern Psychotherapy Services 4875 W Athens Ct Eagle ID 83616-5138 Ph: (208) 731-7646 |
| NPI Number | 1649674888 |
|---|---|
| Provider Enumeration Date | 10/17/2014 |
| Last Update Date | 10/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649674888 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | LPC-5605 (Idaho) | Primary |
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