Provider Demographics
NPI:1366488132
Name:HAMBLIN, ARTHUR G (PSYD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:G
Last Name:HAMBLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 HILL RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-2946
Mailing Address - Country:US
Mailing Address - Phone:208-387-1854
Mailing Address - Fax:208-343-4124
Practice Address - Street 1:5426 HILL RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-2946
Practice Address - Country:US
Practice Address - Phone:208-387-1854
Practice Address - Fax:208-343-4124
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY163103T00000X
IDLMFT2954103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010016554OtherREGENCE BLUE SHIELD OF ID
ID5681430OtherAETNA
IDN1631OtherBLUE CROSS OF IDAHO
ID82051112183703A001OtherTRICARE
ID1839016OtherCIGNA
IDA052837OtherVALUE OPTIONS
ID0001057484OtherMANAGED HEALTH NETWORK