OrganizationActive
New Age Med Clinic
NPI 1831065481 · Behavioral Neurology & Neuropsychiatry Physician · Boise, ID
Provider details
- NPI number
- 1831065481
- Entity type
- Organization
- Primary specialty
- Behavioral Neurology & Neuropsychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- James Donnelly, Co-Owner(208) 573-3053
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Health & Wellness Coach171400000X
Other Service Providers
Practice location
3501 W Elder St Ste 102
Boise, ID 83705-4986
Phone: (208) 573-3053
Approximate (ZIP-level) locationGet directions
Mailing address
4320 W Edgemont St
Boise, ID 83706-2304
Registry dates
- Enumerated
- 2025-10-13
- Last updated
- 2025-10-13
- Certified
- 2025-10-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.