Provider Demographics
NPI:1972645711
Name:HUSKINSON, BECKY JO (PSYD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:JO
Last Name:HUSKINSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 WESTGATE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7174
Mailing Address - Country:US
Mailing Address - Phone:208-373-0790
Mailing Address - Fax:208-373-0816
Practice Address - Street 1:1755 WESTGATE DR
Practice Address - Street 2:SUITE 260
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7174
Practice Address - Country:US
Practice Address - Phone:208-373-0790
Practice Address - Fax:208-373-0816
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDX6919OtherBLUE CROSS