Individual
TYLER T WHITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2273 E GALA ST, SUITE 120, MERIDIAN, ID 83642-7289
(208) 888-7104
(208) 321-4789
Mailing address
2273 E GALA ST, SUITE 120, MERIDIAN, ID 83642-7289
(208) 888-7104
(208) 321-4789
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY202-131
ID
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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