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1164019303
MATTHEW BLAISE MCDANIEL
BOISE, ID
NPI
1164019303
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID LMSW-38732)
Enumeration Date
2020-12-22
Last Update Date
2020-12-22
Business Address
Mr. MATTHEW BLAISE MCDANIEL LMSW
9196 W BARNES DR
BOISE, ID 83709-1552
Phone number: 208-433-0400
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Mailing Address
Mr. MATTHEW BLAISE MCDANIEL LMSW
9196 W BARNES DR
BOISE, ID 83709-1552
Phone number: 208-433-4000
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