Provider Demographics
NPI:1770235921
Name:STRAUSS, MOLLY M (EDS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 N DALTON LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-3204
Mailing Address - Country:US
Mailing Address - Phone:208-724-7172
Mailing Address - Fax:
Practice Address - Street 1:4175 N DALTON LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-3204
Practice Address - Country:US
Practice Address - Phone:208-724-7172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID566777458103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool