Provider Demographics
NPI:1831914787
Name:CALL, TREY SHANE
Entity type:Individual
Prefix:
First Name:TREY
Middle Name:SHANE
Last Name:CALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BRISCOE RD APT C
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2528
Mailing Address - Country:US
Mailing Address - Phone:208-241-5688
Mailing Address - Fax:
Practice Address - Street 1:108 BRISCOE RD APT C
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2528
Practice Address - Country:US
Practice Address - Phone:208-241-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician