1790115137 NPI number — MRS. WHITNEY KATHRYN PRICE LCSW

Table of content: MRS. WHITNEY KATHRYN PRICE LCSW (NPI 1790115137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790115137 NPI number — MRS. WHITNEY KATHRYN PRICE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
WHITNEY
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GODSILL
Provider Other First Name:
WHITNEY
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790115137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6855 W FAIRVIEW AVE
Provider Second Line Business Mailing Address:
#120
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83704-8046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-323-8888
Provider Business Mailing Address Fax Number:
208-323-8889

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6855 W FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
#120
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-8046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-323-8888
Provider Business Practice Location Address Fax Number:
208-323-8889
Provider Enumeration Date:
11/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  35631 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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