NPI age
19 years
Enumerated 2007-03-16
Across 1313 active counselor providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 002269500 | |
| 01 (ID) | X4195 | BLUE CROSS |
| 01 (ID) | 000010032814 | REGENCE BLUE SHIELD |
| 01 (ID) | Q2495 | BLUE CROSS |
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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