| Mountain States Counseling & Psychological Services Plll | |
|
311 Allumbaugh St Boise ID 83704-9208 | |
| (208) 375-6402 | |
| (208) 323-1850 |
| Full Name | Mountain States Counseling & Psychological Services Plll |
|---|---|
| Speciality | Psychologist |
| Location | 311 Allumbaugh St, Boise, Idaho |
| Authorized Official Name and Position | Clay H Ward (MANAGING PARTNER) |
| Authorized Official Contact | 2083756402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain States Counseling & Psychological Services Plll 311 Allumbaugh St Boise ID 83704-9208 Ph: (208) 375-6402 | Mountain States Counseling & Psychological Services Plll 311 Allumbaugh St Boise ID 83704-9208 Ph: (208) 375-6402 |
| NPI Number | 1598959322 |
|---|---|
| Provider Enumeration Date | 09/05/2007 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 6002999570 |
|---|---|
| Medicare Enrollment ID | O20080207000455 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598959322 | NPI | - | NPPES |
| 85902 | Other | ID | BLUE CROSS OF IDAHO |
| 10015901 | Other | ID | REGENCE BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY61 (Idaho) | Primary |
| Provider Name | Robert F Calhoun |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376697946 PECOS PAC ID: 2668408139 Enrollment ID: I20050715000430 |
| Provider Name | Michael D Johnston |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346394913 PECOS PAC ID: 1355424821 Enrollment ID: I20100924000523 |
| Provider Name | Keith L Williams |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1174716005 PECOS PAC ID: 6305093188 Enrollment ID: I20120829000903 |
| Provider Name | Jason D Gage |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548250699 PECOS PAC ID: 6800970807 Enrollment ID: I20130227000275 |
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