Idaho State University, Psychology Clinic

NPI #1174682959 in Pocatello, Idaho

Provider Information

NPI Number: 1174682959
Entity Type: Organization
Organization Name: Idaho State University, Psychology Clinic
Subpart: Yes (part of a larger organization)
Parent Organization: IDAHO STATE UNIVERSITY
Primary Specialty: Community/Behavioral Health
Enumeration Date: Dec 7, 2006
Last Updated: Jun 17, 2008

Practice Location

Address: ISU PSYCHOLOGY CLINIC IDAHO STATE UNIVERSITY
Address 2: 921 S. 8TH AVENUE, STOP 8021
City: Pocatello
State: Idaho
ZIP Code: 83209-0001
Phone: (208) 282-2129

Authorized Official

Name: DR. ANTHONY J. CELLUCCI, PH.D.
Title: DIRECTOR OF PSYCH CLINIC
Phone: (208) 282-2129

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community/Behavioral Health	251S00000X	Primary

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