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1386039675
JACOB COMSTOCK
BLACKFOOT, ID
NPI
1386039675
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: ID LCSW-34156)
Enumeration Date
2015-04-02
Last Update Date
2015-09-28
Business Address
-- JACOB COMSTOCK
412 W PACIFIC ST
BLACKFOOT, ID 83221-1726
Phone number: 208-201-1743
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Mailing Address
-- JACOB COMSTOCK
2420E 25TH ST
IDAHO FALLS, ID 83404-7549
Phone number: 208-542-1026
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