Provider Demographics
NPI:1851912117
Name:HIGH DESERT PSYCHIATRY LLC
Entity Type:Organization
Organization Name:HIGH DESERT PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:HARBISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-315-6444
Mailing Address - Street 1:1775 W STATE ST STE 123
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-3924
Mailing Address - Country:US
Mailing Address - Phone:208-615-6444
Mailing Address - Fax:
Practice Address - Street 1:4477 W EMERALD ST STE C275
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2078
Practice Address - Country:US
Practice Address - Phone:208-315-6444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty