Individual
DANIEL EDWARD TIMBERLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1910 UNIVERSITY DR, MS 1351, BOISE, ID 83725-1351
(208) 426-1459
Mailing address
5840 S HORSESHOE PL, BOISE, ID 83716
(208) 608-6484
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY-202436
ID
Other
Enumeration date
06/23/2011
Last updated
06/23/2011
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