Provider Demographics
NPI:1447070412
Name:PSYCHOLOGICAL EVALUATIONS AND HEALTH SERVICES
Entity type:Organization
Organization Name:PSYCHOLOGICAL EVALUATIONS AND HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:TIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-404-6049
Mailing Address - Street 1:133 MAIN AVE W STE 600
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-6580
Mailing Address - Country:US
Mailing Address - Phone:208-404-6049
Mailing Address - Fax:
Practice Address - Street 1:133 MAIN AVE W STE 600
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6580
Practice Address - Country:US
Practice Address - Phone:208-404-6049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty