Provider Demographics
NPI:1255459608
Name:KENNETH P. LINDSEY, PHD, PA
Entity type:Organization
Organization Name:KENNETH P. LINDSEY, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:LINDSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-237-2446
Mailing Address - Street 1:PO BOX 4285
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4285
Mailing Address - Country:US
Mailing Address - Phone:208-236-1600
Mailing Address - Fax:208-236-6695
Practice Address - Street 1:1151D HOSPITAL WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2763
Practice Address - Country:US
Practice Address - Phone:208-237-2446
Practice Address - Fax:208-237-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY327103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty