Organization
IDAHO STATE UNIVERSITY, PSYCHOLOGY CLINIC
Active
Parent organization
IDAHO STATE UNIVERSITY
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO STATE UNIVERSITY
Authorized official
DR. ANTHONY J. CELLUCCI PH.D. (DIRECTOR OF PSYCH CLINIC)
(208) 282-2129
Entity
Organization
Contact information
Practice address
ISU PSYCHOLOGY CLINIC IDAHO STATE UNIVERSITY, 921 S. 8TH AVENUE, STOP 8021, POCATELLO, ID 83209-0001
(208) 282-2129
(208) 282-5411
Mailing address
ISU PSYCHOLOGY CLINIC IDAHO STATE UNIVERSITY, 921 S. 8TH AVENUE, STOP 8021, POCATELLO, ID 83209-0001
(208) 282-2129
(208) 282-5411
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
344
ID
Other
Enumeration date
12/07/2006
Last updated
06/17/2008
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