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1295939080
RANDY WILD
BOISE, ID
NPI
1295939080
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: OR C1740)
Enumeration Date
2007-06-13
Last Update Date
2024-02-14
Business Address
RANDY WILD LCPC
3152 S BOWN WAY STE 103
BOISE, ID 83706-5456
Phone number: 541-550-7940
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Mailing Address
RANDY WILD LCPC
3152 S BOWN WAY STE 103
BOISE, ID 83706-5456
Phone number: 541-550-7940
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