Provider Demographics
NPI:1902906209
Name:ATER, STEVEN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:L
Last Name:ATER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S. 11TH ST.
Mailing Address - Street 2:PORTNEUF MEDICAL CENTER BEHAVIORAL HEALTH
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201
Mailing Address - Country:US
Mailing Address - Phone:435-828-8028
Mailing Address - Fax:
Practice Address - Street 1:500 S. 11TH ST.
Practice Address - Street 2:PORTNEUF MEDICAL CENTER
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:435-828-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5525037-2501103G00000X, 103T00000X, 103TC0700X, 103TC2200X
IDPSY-202491103G00000X, 103T00000X, 103TC0700X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily