Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY-413 | ID |
NPI | 1053461186 |
---|---|
Provider Name | Dr. Frank Andrews |
First Address | Hailey, ID 83333-8431 |
Second Address | Hailey, ID 83333-8431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 25/01/2010 |