1114228384

Everything you always wanted to know about DE WALL ANDREW ROBERT LPC but were afraid to ask.

DE WALL ANDREW ROBERT LPC

You can also download the this 1114228384 data report as csv | excel | json | xml
Provider Last Name Provider Middle Name Provider First Name Provider Credential
DE WALL ANDREW ROBERT LPC
Gender:
Male
Enumeration date:
2010-11-04
Last update date:
2010-11-04
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
101YP2500X Professional ID LPC-4188 Y

Phone Numbers

Type Number
Practice Location Address Telephone Number 2082342600
Mailing Address Fax Number 2082342800
Practice Location Address Fax Number 2082342800
Mailing Address Telephone Number 2083170027

Addresses

Type Address City State Postal Country
Mailing Address 65 FORDHAM ST SUITE B POCATELLO ID 83201 ID
Practice Location Address 210 E CENTER ST POCATELLO ID 83201 ID

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1043457021 BEHAVIORAL TREATMENT SERVICES
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210 E CENTER ST STE B ID POCATELLO
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210 E CENTER ST STE B ID POCATELLO
1215188479 CORNELISON, TANJA
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210 E CENTER ST STE B ID POCATELLO
1245368398 MUEGERL, TERRI
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210 E CENTER ST ID POCATELLO
1295855963 GRAVELLE, SHAWN
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210 E CENTER ST ID POCATELLO
1366519761 BEHAVIORAL TREATMENT CENTER, L
Organization
210 E CENTER ST ID POCATELLO
1366781262 THORNGREN, GAIL
Individual
201 E CENTER ST STE B ID POCATELLO
1831336841 YOUNG, KEVIN
Individual
210 E CENTER ST STE B ID POCATELLO
1952423519 BEHAVIORAL TREATMENT SERVICES
Organization
210 E CENTER ST ID POCATELLO

Other NPI Records that share an address

NPI Name Address State City
1245368398 MUEGERL, TERRI
Individual
210 E CENTER ST ID POCATELLO
1295855963 GRAVELLE, SHAWN
Individual
210 E CENTER ST ID POCATELLO
1366519761 BEHAVIORAL TREATMENT CENTER, L
Organization
210 E CENTER ST ID POCATELLO
1952423519 BEHAVIORAL TREATMENT SERVICES
Organization
210 E CENTER ST ID POCATELLO