Provider Demographics
NPI:1225155575
Name:REHNBERG, TIMOTHY SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:REHNBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W A ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4042
Mailing Address - Country:US
Mailing Address - Phone:208-883-1144
Mailing Address - Fax:208-883-8062
Practice Address - Street 1:2301 W A ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4042
Practice Address - Country:US
Practice Address - Phone:208-883-1144
Practice Address - Fax:208-883-8062
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY280103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist