Organization
IDAHO PSYCHIATRIC INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWN THURBER PH.D., LMFT (PRESIDENT)
(208) 529-4300
Entity
Organization
Contact information
Practice address
1975 MARTHA AVE, IDAHO FALLS, ID 83404-7580
(208) 529-4300
(208) 529-1627
Mailing address
1975 MARTHA AVE, IDAHO FALLS, ID 83404-7580
(208) 529-4300
(208) 529-1627
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT965
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808091300
—
ID
05
—
808091400
—
ID
Enumeration date
04/06/2010
Last updated
04/06/2010
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