NPI age
19 years
Enumerated 2007-04-11
Across 1313 active counselor providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | X5663 | BLU CROSS |
| 01 (ID) | 481086633 | TAX IDENTIFICATION NUMBER |
| 05 (ID) | 805997100 | |
| 01 (ID) | 000010003974 | BLUE SHIELD |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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