Provider Demographics
NPI:1740343235
Name:EISENBEISS, MICHAEL JOHN SR (PSYCHOLOGIST COUNSEL)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:EISENBEISS
Suffix:SR
Gender:M
Credentials:PSYCHOLOGIST COUNSEL
Other - Prefix:
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Mailing Address - Street 1:315 N ALLEMBAUGH
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704
Mailing Address - Country:US
Mailing Address - Phone:208-376-3546
Mailing Address - Fax:208-345-4425
Practice Address - Street 1:315 N ALLEMBAUGH
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704
Practice Address - Country:US
Practice Address - Phone:208-376-3546
Practice Address - Fax:208-345-4425
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDLPC286101YM0800X
IDPSY57103TC0700X
IDLMFT19106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist