| Psychological Consultants, Pc | |
|
100 N 1st Ave Sandpoint ID 83864-1376 | |
| (208) 263-2040 | |
| Not Available |
| Full Name | Psychological Consultants, Pc |
|---|---|
| Speciality | Psychologist |
| Location | 100 N 1st Ave, Sandpoint, Idaho |
| Authorized Official Name and Position | Gloria J Waterhouse (SOLE OWNER) |
| Authorized Official Contact | 2082632040 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychological Consultants, Pc 100 N 1st Ave Sandpoint ID 83864-1376 Ph: (208) 263-2040 | Psychological Consultants, Pc 100 N 1st Ave Sandpoint ID 83864-1376 Ph: (208) 263-2040 |
| NPI Number | 1437452828 |
|---|---|
| Provider Enumeration Date | 12/07/2010 |
| Last Update Date | 12/07/2010 |
| Medicare PECOS PAC ID | 3870773211 |
|---|---|
| Medicare Enrollment ID | O20110202000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437452828 | NPI | - | NPPES |
| 8066666574200 | Medicaid | ID | |
| N5327 | Other | ID | BLUE CROSS |
| 86519 | Other | ID | REGENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY-202071 (Idaho) | Primary |
| Provider Name | Gloria J Waterhouse |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174702385 PECOS PAC ID: 1557251808 Enrollment ID: I20040318001460 |
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