BEVIN JAY MODRAK

BOISE, ID
NPI1326316514
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: ID  LCPC4698)
Enumeration Date2011-12-02
Last Update Date2023-03-29
Business Address
Mr. BEVIN JAY MODRAK LCPC
204 S COLE RD
BOISE, ID 83709-0934
Phone number: 208-319-9786
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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