Provider Demographics
NPI:1003598020
Name:BOISE BEHAVIORAL MEDICINE PLLC
Entity type:Organization
Organization Name:BOISE BEHAVIORAL MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PA
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SALZSIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-314-1770
Mailing Address - Street 1:7227 W POTOMAC DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9109
Mailing Address - Country:US
Mailing Address - Phone:208-314-1770
Mailing Address - Fax:
Practice Address - Street 1:7227 W POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9109
Practice Address - Country:US
Practice Address - Phone:208-314-1770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty