Basic Information
| Provider Information | |||||||||
| NPI: | 1295328045 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEXT LEVEL PSYCHIATRY IDAHO PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2831 SAINT ROSE PKWY STE 221 | ||||||||
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| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025894871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 784 S CLEARWATER LOOP STE R | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838549599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025894871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2021 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | TREESE | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7025894871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.