Provider Demographics
NPI:1861755068
Name:DAY, DAN EARNEST (PHD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:EARNEST
Last Name:DAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 N CRESTMONT DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2184
Mailing Address - Country:US
Mailing Address - Phone:208-898-0988
Mailing Address - Fax:208-898-9022
Practice Address - Street 1:1550 N CRESTMONT DR
Practice Address - Street 2:SUITE E
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2184
Practice Address - Country:US
Practice Address - Phone:208-898-0988
Practice Address - Fax:208-898-9022
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-354103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent