Provider Demographics
NPI:1619114139
Name:WILLIAM MCKEE
Entity Type:Organization
Organization Name:WILLIAM MCKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-237-1711
Mailing Address - Street 1:4460 CENTRAL WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5095
Mailing Address - Country:US
Mailing Address - Phone:208-237-1711
Mailing Address - Fax:208-237-5192
Practice Address - Street 1:4460 CENTRAL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-5095
Practice Address - Country:US
Practice Address - Phone:208-237-1711
Practice Address - Fax:208-237-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807197600Medicaid