Provider Demographics
NPI:1093844474
Name:JAY W. WEBB, PH.D., P.A.
Entity Type:Organization
Organization Name:JAY W. WEBB, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-376-0453
Mailing Address - Street 1:2304 N. COLE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-376-0453
Mailing Address - Fax:208-376-0477
Practice Address - Street 1:2304 N. COLE RD.
Practice Address - Street 2:SUITE B
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-376-0453
Practice Address - Fax:208-376-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty