Doctor Name: | DR. WINSLOW GREGORY GERRISH |
NPI Number: | 1013297621 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PSY-202684 |
Business Practice Address: | 777 N Raymond St Boise, ID - 837049251 |
Business Phone Number: | 2085142500 |
Business Fax Number: | 2083752217 |
Mailing Address: | 777 N Raymond St, BOISE |
State: | ID |
Postal Code: | 837049251 |
Phone Number: | 2085142500 |
Fax Number: | 2083752217 |
NPI Enumeration Date: | 08/26/2011 |
NPI Last Update Date: | 08/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY-202684 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |