Basic Information
| Provider Information | |||||||||
| NPI: | 1720586969 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH END PSYCHIATRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1423 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837025024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083452212 | ||||||||
| FaxNumber: | 2083452282 | ||||||||
| Practice Location | |||||||||
| Address1: | 1423 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837025024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083452212 | ||||||||
| FaxNumber: | 2083452282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 01/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | MONTGOMERY | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2083452212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 363LP0808X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.