Provider Demographics
NPI:1750273827
Name:IVERS, HEATH RICHARD (BCBA)
Entity type:Individual
Prefix:
First Name:HEATH
Middle Name:RICHARD
Last Name:IVERS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 11TH AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4881
Mailing Address - Country:US
Mailing Address - Phone:208-478-9344
Mailing Address - Fax:208-478-9368
Practice Address - Street 1:2222 TETON PLZ STE 2
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6485
Practice Address - Country:US
Practice Address - Phone:208-522-4026
Practice Address - Fax:208-522-4138
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA12578953103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst