Organization
SUMMIT HEALTH PROFESSIONALS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIKOLA ANDERSEN (PHYSICIAN/PARTNER)
(208) 524-4953
Entity
Organization
Contact information
Practice address
3760 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7593
(208) 524-4953
(208) 524-7335
Mailing address
3760 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7593
(208) 524-4953
(208) 524-7335
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LCPC-323
ID
104100000X
Social Worker
LCSW-1311
ID
2084P0800X
Psychiatry Physician
M8621
ID
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806797700
—
ID
Enumeration date
08/16/2005
Last updated
11/03/2008
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