Organization
MOUNTAIN STATES COUNSELING & PSYCHOLOGICAL SERVICES PLLL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAY H WARD PHD (MANAGING PARTNER)
(208) 375-6402
Entity
Organization
Contact information
Practice address
311 ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 375-6402
(208) 323-1850
Mailing address
311 ALLUMBAUGH ST, BOISE, ID 83704-9208
(208) 375-6402
(208) 323-1850
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY61
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10015901
REGENCE BLUE SHIELD
ID
01
—
85902
BLUE CROSS OF IDAHO
ID
Enumeration date
09/05/2007
Last updated
04/20/2008
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