Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY-202431 | ID |
Y | 103TC0700X | Clinical Psychologist | PSY-202431 | ID |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY-202431 | ID |
N | 103TF0000X | Family Psychologist | PSY-202431 | ID |
NPI | 1134248750 |
---|---|
Provider Name | Dr. Sheila Sturgeon Freitas |
First Address | Meridian, ID 83646-5924 |
Second Address | Meridian, ID 83646-5924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010168149 | BLUE SHIELD OF IDAHO (01) | ID |
N6342 | BLUE CROSS OF IDAHO (01) |