Provider Demographics
NPI:1720076326
Name:MEHARRY, STEVEN L (PSY D)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:MEHARRY
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-0578
Mailing Address - Country:US
Mailing Address - Phone:208-863-6744
Mailing Address - Fax:208-938-1399
Practice Address - Street 1:3775 N EAGLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5005
Practice Address - Country:US
Practice Address - Phone:208-863-6744
Practice Address - Fax:208-938-1399
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDN5483OtherBLUE CROSS
ID000010033578OtherREGENCE BLUE SHIELD
IDN5483OtherBLUE CROSS