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1326316514
BEVIN JAY MODRAK
BOISE, ID
NPI
1326316514
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LCPC4698)
Enumeration Date
2011-12-02
Last Update Date
2023-03-29
Business Address
Mr. BEVIN JAY MODRAK LCPC
204 S COLE RD
BOISE, ID 83709-0934
Phone number: 208-319-9786
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Mailing Address
Mr. BEVIN JAY MODRAK LCPC
6568 S FEDERAL WAY #124
BOISE, ID 83716-9277
Phone number: 208-283-9710
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