Provider Demographics
NPI:1215783212
Name:DR. FACER PSYCHIATRY PLLC
Entity type:Organization
Organization Name:DR. FACER PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KADEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FACER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-861-7841
Mailing Address - Street 1:1846 1ST ST. SUITE 242
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-9599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1846 1ST ST. SUITE 242
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-9599
Practice Address - Country:US
Practice Address - Phone:406-861-7841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty