NPI age
19 years
Enumerated 2007-04-12
Across 1998 active counselor providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010148813 | REGENCE BLUE SHIELD |
| 05 (ID) | 806968300 | |
| 01 (ID) | 8N639 | BLUE CROSS OF IDAHO |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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