| Rjb Psychology, Pllc | |
|
13945 W Wainwright Dr Ste 106 Boise ID 83713-1925 | |
| (208) 377-1131 | |
| Not Available |
| Full Name | Rjb Psychology, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 13945 W Wainwright Dr Ste 106, Boise, Idaho |
| Authorized Official Name and Position | Raydell J Booth (OWNER) |
| Authorized Official Contact | 2083771131 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rjb Psychology, Pllc 13945 W Wainwright Dr Ste 106 Boise ID 83713-1925 Ph: (208) 377-1131 | Rjb Psychology, Pllc 13945 W Wainwright Dr Ste 106 Boise ID 83713-1925 Ph: (208) 377-1131 |
| NPI Number | 1225521164 |
|---|---|
| Provider Enumeration Date | 06/13/2018 |
| Last Update Date | 06/13/2018 |
| Medicare PECOS PAC ID | 1759633571 |
|---|---|
| Medicare Enrollment ID | O20181005001545 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225521164 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY-211 (Idaho) | Primary |
| Provider Name | Raydell J Booth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184661175 PECOS PAC ID: 9436174570 Enrollment ID: I20051007000806 |
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