| Psychology Center Of Idaho Falls | |
|
3670 S 25th E Ste 2 Idaho Falls ID 83404-4956 | |
| (208) 522-3404 | |
| (208) 524-1093 |
| Full Name | Psychology Center Of Idaho Falls |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3670 S 25th E Ste 2, Idaho Falls, Idaho |
| Authorized Official Name and Position | Carol Vernon Anderson (PRESIDENT, CLIICAL NEUROPSYCHOLOGIS) |
| Authorized Official Contact | 2085223404 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychology Center Of Idaho Falls 3670 S 25th E Ste 2 Idaho Falls ID 83404-4956 Ph: (208) 522-3404 | Psychology Center Of Idaho Falls 3670 S 25th E Ste 2 Idaho Falls ID 83404-4956 Ph: (208) 522-3404 |
| NPI Number | 1780010090 |
|---|---|
| Provider Enumeration Date | 09/18/2013 |
| Last Update Date | 09/18/2013 |
| Medicare PECOS PAC ID | 1658699145 |
|---|---|
| Medicare Enrollment ID | O20150413002170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780010090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 202288 (Idaho) | Primary |
| Provider Name | Carol V Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396878401 PECOS PAC ID: 3072666387 Enrollment ID: I20090804000800 |
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