OrganizationActive
Lifestance Health - Idaho, PC Dba Lifestance Health
NPI 1407787336 · Behavioral Neurology & Neuropsychiatry Physician · Boise, ID
Provider details
- NPI number
- 1407787336
- Entity type
- Organization
- Primary specialty
- Behavioral Neurology & Neuropsychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Ryan Pardo, Chief Legal Officer(425) 279-8500
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Counselor101Y00000X
Behavioral Health & Social Service Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Social Worker104100000X
Behavioral Health & Social Service Providers
- Clinical Social Worker1041C0700X
Behavioral Health & Social Service Providers
- Marriage & Family Therapist106H00000X
Behavioral Health & Social Service Providers
Practice location
950 W Bannock St Ste 1100
Boise, ID 83702-6140
Phone: (253) 346-0399
Approximate (ZIP-level) locationGet directions
Mailing address
4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630
Registry dates
- Enumerated
- 2026-05-28
- Last updated
- 2026-05-28
- Certified
- 2026-05-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.