Organization
JCW PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERI PETERSON (CREDENTIALER)
(208) 954-5594
Entity
Organization
Contact information
Practice address
413 N ALLUMBAUGH ST STE 101, BOISE, ID 83704-9219
(208) 323-1125
(208) 323-9604
Mailing address
413 N ALLUMBAUGH ST STE 101, BOISE, ID 83704-9219
(208) 323-1125
(208) 323-9604
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
07/28/2020
Last updated
07/28/2020
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