NPI age
19 years
Enumerated 2006-11-28
Across 1998 active counselor providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010149104 | BLUESHIELD PROVIDER # |
| 01 (ID) | Q7365 | PROVIDER # FOR CLINIC |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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