Organization
NORTHWEST NEUROBEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY EVANS (BILLING SUPERVISOR)
(208) 323-9130
Entity
Organization
Contact information
Practice address
2950 E MAGIC VIEW DR STE 140, MERIDIAN, ID 83642-9273
(208) 323-9130
(208) 323-9070
Mailing address
2950 E MAGIC VIEW DR STE 140, MERIDIAN, ID 83642-9273
(208) 323-9130
(208) 323-9070
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY-202444
ID
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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