BENTON WAGNER

HAILEY, ID
NPI1346668852
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: ID  LCPC-6760)
Enumeration Date2014-04-01
Last Update Date2024-03-05
Business Address
BENTON WAGNER
418 N RIVER ST
HAILEY, ID 83333-8513
Phone number: 612-247-9768
Mailing Address
BENTON WAGNER
PO BOX 424
FAIRFIELD, ID 83327-0424
Phone number: 612-247-9768
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