Provider Demographics
NPI:1063424448
Name:AUBREY, DEBRA L (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:AUBREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 HILINE ROAD
Mailing Address - Street 2:STE 250
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2955
Mailing Address - Country:US
Mailing Address - Phone:208-742-6400
Mailing Address - Fax:208-742-6444
Practice Address - Street 1:1070 HILINE ROAD
Practice Address - Street 2:STE 250
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2955
Practice Address - Country:US
Practice Address - Phone:208-742-6400
Practice Address - Fax:208-742-6444
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-202099103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist