Individual
CRAIG W. BEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
250 BOBWHITE CT STE 220, BOISE, ID 83706-3983
(208) 336-2972
(208) 336-4408
Mailing address
250 BOBWHITE CT STE 220, BOISE, ID 83706-3983
(208) 336-2972
(208) 336-4408
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY-173
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010016209
BLUE SHIELD
ID
01
—
N1730
BLUE CROSS
ID
Enumeration date
02/01/2007
Last updated
07/08/2007
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