Individual
LARKIN ELIZABETH MAGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
311 N ALLUMBAUGH ST, BOISE, ID 83702
(208) 375-6402
(208) 323-1850
Mailing address
311 N ALLUMBAUGH ST, BOISE, ID 83702
(208) 375-6402
(208) 323-1850
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PSY17888
CA
103T00000X
Psychologist
Primary
PSY202324
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010158240
REGENCE BLUE SHIELD
ID
01
—
N6290
BLUE CROSS
ID
Enumeration date
11/28/2006
Last updated
07/08/2007
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