DR. MARDI STACY (NPI# 1417025974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417025974 |
| Entity Type | Individual |
| Full Name | DR. MARDI STACY |
| Credential | PH.D. |
| Practice Address |
1718 W Jefferson St Boise ID 83702-3949 |
| Practice Telephone | 2084248130 |
| Practice Fax Number | 2084248137 |
| Mailing Telephone | 2084248130 |
| Mailing Fax Number | 2084248137 |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
PSY-429 | ID | Behavioral Health & Social Service Providers |
| Street Address |
1718 W JEFFERSON ST |
| City | BOISE |
| State | ID |
| Zip Code | 83702-3949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598725277 | Renee Ours Bild | Social Worker | 1718 W Jefferson St, Boise, ID 83702-3949 | 2006-03-25 |
| 1174916969 | Renee O. Bild, Pllc | Clinic/Center | 1718 W Jefferson St, Boise, ID 83702-3949 | 2015-03-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376164723 | Krystal Anne Wood | Psychologist | 605 E Holly St Apt 206, Boise, ID 83712-7882 | 2020-04-27 |
| 1467994616 | Heather Eskridge Hoyt Phd LLC | Psychologist | 671 E Riverpark Lane Ste 220, Boise, ID 83706-6559 | 2016-11-04 |
| 1144771338 | Heather E Hoyt | Psychologist | 671 E Riverpark Ln, Suite 220, Boise, ID 83706-6559 | 2016-10-22 |
| 1750680849 | Alison Radcliffe | Psychologist | 1529 S Belmont St, Boise, ID 83725-0001 | 2011-03-15 |
| 1518102797 | Northwest Neurobehavioral Health Pllc | Psychologist | 6003 Overland Rd Ste 301, Boise, ID 83709-3077 | 2008-12-02 |
| 1225222433 | Ronald B Tye | Psychologist | 6003 Overland Rd, Suite 301, Boise, ID 83709-3073 | 2007-08-30 |
| 1174716005 | Keith Lee Williams | Psychologist | 3771 N Eagle Rd, Boise, ID 83713-5005 | 2007-08-23 |
| 1982738563 | Michael Loren Hillam | Psychologist | 4696 W Overland Rd Ste 156, Boise, ID 83705-2878 | 2007-03-15 |
| 1629107321 | Center for Christian Therapy, Inc. | Psychologist | 3631 W Overland Rd, Boise, ID 83705-6033 | 2007-03-06 |
| 1093844474 | Jay W. Webb, Ph.d., P.a. | Psychologist | 2304 N. Cole Rd., Suite B, Boise, ID 83704 | 2007-03-03 |
| Find all providers in BOISE | ||||
Please comment or provide details below to improve the information on DR. MARDI STACY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.