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PSYCHOLOGY CENTER OF IDAHO FALLS

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Company Details

Name: PSYCHOLOGY CENTER OF IDAHO FALLS
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 07 Feb 2018 (7 years ago)
Entity Number: 602532
Place of Formation: IDAHO
File Number: 0000602532
ZIP code: 83404
County: Bonneville County
Mailing Address: 3670 S 25TH E STE 2 IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1780010090

Authorized Person:

Name:
DR. CAROL VERNON ANDERSON
Role:
PRESIDENT, CLIICAL NEUROPSYCHOLOGIS
Phone:

Taxonomy:

Selected Taxonomy:
103G00000X - Clinical Neuropsychologist
Is Primary:
Yes

Contacts:

Fax:
2085241093

Filing

Filing Name Filing Number Filing date
Initial Filing 0000602532 2018-02-07

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State