Organization
PSYCHOLOGICAL CONSULTANTS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLORIA J WATERHOUSE PHD (SOLE OWNER)
(208) 263-2040
Entity
Organization
Contact information
Practice address
100 N 1ST AVE, SANDPOINT, ID 83864-1376
(208) 263-2040
Mailing address
100 N 1ST AVE, SANDPOINT, ID 83864-1376
(208) 263-2040
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY-202071
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8066666574200
—
ID
01
—
86519
REGENCE
ID
01
—
N5327
BLUE CROSS
ID
Enumeration date
12/07/2010
Last updated
12/07/2010
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