Doctor Name: | SALLY MCCOLLUM |
NPI Number: | 1609984210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | PSY 237 |
Business Practice Address: | 171 W. 1st St #1 Ketchum, ID - 833406078 |
Business Phone Number: | 2087268926 |
Business Fax Number: | 2087268926 |
Mailing Address: | Po Box 6078, KETCHUM |
State: | ID |
Postal Code: | 833406078 |
Phone Number: | 2087268926 |
Fax Number: | 2087268926 |
NPI Enumeration Date: | 08/25/2006 |
NPI Last Update Date: | 01/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY 237 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |