Provider Demographics
NPI:1598892143
Name:VIK, PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:VIK
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:ISU PSYCHOLOGY CLINIC
Mailing Address - Street 2:IDAHO STATE UNIVERSITY STOP 8021
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-8021
Mailing Address - Country:US
Mailing Address - Phone:208-282-2129
Mailing Address - Fax:208-282-5411
Practice Address - Street 1:ISU PSYCHOLOGY CLINIC
Practice Address - Street 2:IDAHO STATE UNIVERSITY STOP 8021
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-2129
Practice Address - Fax:208-282-5411
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical