Individual
DR. ELENA MAYVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
1004 W FORT ST, BOISE, ID 83702-5427
(212) 254-3967
Mailing address
1004 W FORT ST, BOISE, ID 83702-5427
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
021223
NY
103TC0700X
Clinical Psychologist
203487
ID
Other
Enumeration date
07/01/2011
Last updated
06/27/2023
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