Provider Demographics
NPI:1437362704
Name:APEX PROFESSIONAL SERVICES
Entity Type:Organization
Organization Name:APEX PROFESSIONAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MC, LCPC
Authorized Official - Phone:208-904-0225
Mailing Address - Street 1:PO BOX 2297
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2297
Mailing Address - Country:US
Mailing Address - Phone:208-904-0225
Mailing Address - Fax:866-704-4580
Practice Address - Street 1:611 WILSON AVE
Practice Address - Street 2:SUITE 3-C
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5046
Practice Address - Country:US
Practice Address - Phone:208-904-0225
Practice Address - Fax:866-704-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8060767Medicaid