Organization
PSYCHIATRIC SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE JOHANSEN (ADMINISTRATOR)
(208) 732-0995
Entity
Organization
Contact information
Practice address
493 EASTLAND DR, TWIN FALLS, ID 83301-7480
(208) 732-0995
(208) 732-0993
Mailing address
PO BOX 47, TWIN FALLS, ID 83303-0047
(208) 732-0995
(208) 732-0993
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
CNS12
ID
2084P0800X
Psychiatry Physician
Primary
LCPC3404
ID
2084P0800X
Psychiatry Physician
LCPC3433
ID
2084P0800X
Psychiatry Physician
LMFT-2687
ID
2084P0800X
Psychiatry Physician
LPC3381
ID
2084P0800X
Psychiatry Physician
M5371
ID
2084P0800X
Psychiatry Physician
PA499
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010028578
BLUSHILD GROUP
ID
Enumeration date
12/04/2006
Last updated
08/22/2020
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