Provider Demographics
NPI:1740386523
Name:DELAWYER, DAVID DEAN (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DEAN
Last Name:DELAWYER
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 1:413 N ALLUMBAUGH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9219
Mailing Address - Country:US
Mailing Address - Phone:208-389-2166
Mailing Address - Fax:208-343-4458
Practice Address - Street 1:413 N ALLUMBAUGH ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9219
Practice Address - Country:US
Practice Address - Phone:208-389-2166
Practice Address - Fax:208-343-4458
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY251103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN2514OtherBLUE CROSS OF IDAHO
ID000010016144OtherREGENCE BLUE SHIELD OF ID