Provider Demographics
NPI:1346229432
Name:WARD, YVETTE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5023
Mailing Address - Country:US
Mailing Address - Phone:208-343-0647
Mailing Address - Fax:208-395-1948
Practice Address - Street 1:90 HOPE DR
Practice Address - Street 2:BLDG #6000
Practice Address - City:MOUNTAIN HOME A F B
Practice Address - State:ID
Practice Address - Zip Code:83648-1057
Practice Address - Country:US
Practice Address - Phone:208-828-7580
Practice Address - Fax:208-828-7520
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-412103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN5152OtherBLUE CROSS
ID0086224OtherBLUE SHIELD
ID1684473Medicare ID - Type Unspecified