| Mary Davis, Phd Pllc | |
|
1221 W Hays St Boise ID 83702-5316 | |
| (208) 345-7358 | |
| Not Available |
| Full Name | Mary Davis, Phd Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 1221 W Hays St, Boise, Idaho |
| Authorized Official Name and Position | Mary Davis (PSYCHOLOGIST) |
| Authorized Official Contact | 2083457358 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Davis, Phd Pllc 1221 W Hays St Boise ID 83702-5316 Ph: (208) 345-7358 | Mary Davis, Phd Pllc 1221 W Hays St Boise ID 83702-5316 Ph: (208) 345-7358 |
| NPI Number | 1366466021 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3173526225 |
|---|---|
| Medicare Enrollment ID | O20060810000474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366466021 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY-275 (Idaho) | Primary |
| Provider Name | Mary A Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1912948563 PECOS PAC ID: 0143124503 Enrollment ID: I20041116000688 |
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