Provider Demographics
NPI:1073793097
Name:VAN DER EIJK, LOUISE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:T
Last Name:VAN DER EIJK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 E PARKCENTER BLVD # 240
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6721
Mailing Address - Country:US
Mailing Address - Phone:208-621-4001
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER STE 320
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-621-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH6495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health