Organization
EAGLE CREST LIFE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WHEELER (PRESIDENT)
(208) 666-9162
Entity
Organization
Contact information
Practice address
416 E COEUR DALENE AVE, COEUR D ALENE, ID 83814-2825
(208) 666-9162
Mailing address
PO BOX 3723, COEUR D ALENE, ID 83816-2529
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
—
—
Other
Enumeration date
05/30/2007
Last updated
08/22/2020
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