Provider Demographics
NPI:1417370842
Name:CHIEF TAHGEE ELEMENTARY ACADEMY, INC.
Entity type:Organization
Organization Name:CHIEF TAHGEE ELEMENTARY ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/COORD. CUR. & INSTRUC.
Authorized Official - Prefix:DR
Authorized Official - First Name:CYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:208-237-2710
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:FORT HALL
Mailing Address - State:ID
Mailing Address - Zip Code:83203-0217
Mailing Address - Country:US
Mailing Address - Phone:208-237-2710
Mailing Address - Fax:208-237-1734
Practice Address - Street 1:38 S HILINE RD
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202
Practice Address - Country:US
Practice Address - Phone:208-237-2710
Practice Address - Fax:208-237-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty