Provider Demographics
NPI:1457466260
Name:ANDELIN, STERLING DON (PHD)
Entity Type:Individual
Prefix:DR
First Name:STERLING
Middle Name:DON
Last Name:ANDELIN
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 1:2465 BRIARCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6318
Mailing Address - Country:US
Mailing Address - Phone:208-589-1013
Mailing Address - Fax:208-523-5591
Practice Address - Street 1:2539 CHANNING WAY
Practice Address - Street 2:SUITE # 260
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7544
Practice Address - Country:US
Practice Address - Phone:208-589-1013
Practice Address - Fax:208-523-5991
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-111103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical