Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3233 | ID |
N | 103T00000X | Psychologist | 3233 | ID |
N | 103TA0700X | Adult Development & Aging Psychologist | 3233 | ID |
N | 103G00000X | Clinical Psychologist | 3233 | ID |
N | 103TC0700X | Clinical Psychologist | 3233 | ID |
N | 103TC1900X | Counseling Psychologist | 3233 | ID |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 3233 | ID |
N | 103TF0000X | Family Psychologist | 3233 | ID |
N | 103TH0100X | Health Service | 3233 | ID |
N | 103TP2701X | Group Psychotherapist | 3233 | ID |
N | 103TR0400X | Rehabilitation Psychologist | 3233 | ID |
NPI | 1316050131 |
---|---|
Provider Name | Dr. Elizabeth Irene Fassig |
First Address | Boise, ID 83709-7830 |
Second Address | Boise, ID 83702-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |