| Idaho State University, Psychology Clinic | |
|
Isu Psychology Clinic Idaho State University 921 S. 8th Avenue, Stop 8021 Pocatello ID 83209-0001 | |
| (208) 282-2129 | |
| (208) 282-5411 |
| Full Name | Idaho State University, Psychology Clinic |
|---|---|
| Speciality | Community/behavioral Health |
| Location | Isu Psychology Clinic Idaho State University, Pocatello, Idaho |
| Authorized Official Name and Position | Anthony J. Cellucci (DIRECTOR OF PSYCH CLINIC) |
| Authorized Official Contact | 2082822129 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho State University, Psychology Clinic Isu Psychology Clinic Idaho State University 921 S. 8th Avenue, Stop 8021 Pocatello ID 83209-0001 Ph: (208) 282-2129 | Idaho State University, Psychology Clinic Isu Psychology Clinic Idaho State University 921 S. 8th Avenue, Stop 8021 Pocatello ID 83209-0001 Ph: (208) 282-2129 |
| NPI Number | 1174682959 |
|---|---|
| Provider Enumeration Date | 12/07/2006 |
| Last Update Date | 06/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174682959 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 344 (Idaho) | Primary |
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