Provider Demographics
NPI:1982917472
Name:FLORES, PAULETTE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:A
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAULETTE
Other - Middle Name:A
Other - Last Name:FLORES - ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2280 AMERICAN LEGION BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3142
Mailing Address - Country:US
Mailing Address - Phone:502-640-1902
Mailing Address - Fax:
Practice Address - Street 1:2280 AMERICAN LEGION BLVD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3142
Practice Address - Country:US
Practice Address - Phone:208-587-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130557103TC0700X
IDPSY-203245103TC0700X
KY2011-78103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical