| Treasure Valley Psychological Services | |
|
6003 Overland Road Ste 301 Boise ID 83709-3014 | |
| (208) 672-8699 | |
| (208) 672-9308 |
| Full Name | Treasure Valley Psychological Services |
|---|---|
| Speciality | Psychologist |
| Location | 6003 Overland Road Ste 301, Boise, Idaho |
| Authorized Official Name and Position | Ronald B Tye (CLINICAL DIRECTOR PRESIDENT) |
| Authorized Official Contact | 2086728699 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Treasure Valley Psychological Services 6003 Overland Road Ste 301 Boise ID 83709-3014 Ph: (208) 672-8699 | Treasure Valley Psychological Services 6003 Overland Road Ste 301 Boise ID 83709-3014 Ph: (208) 672-8699 |
| NPI Number | 1194837351 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 08/15/2012 |
| Medicare PECOS PAC ID | 1052400520 |
|---|---|
| Medicare Enrollment ID | O20071205000743 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194837351 | NPI | - | NPPES |
| 000010017563 | Other | ID | BLUE SHIELD |
| N5228 | Other | ID | BLUE CROSS |
| 805455300 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY316 (Idaho) | Primary |
| 103TC0700X | Psychologist - Clinical | PSY3208 (Arizona) | Secondary |
| Provider Name | Ronald Burwell Tye |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1225222433 PECOS PAC ID: 8426065319 Enrollment ID: I20060317000421 |
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