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1457190951
ROBERT DAVENPORT
POCATELLO, ID
NPI
1457190951
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: ID LPC-10498)
Enumeration Date
2024-05-23
Last Update Date
2024-05-23
Business Address
ROBERT DAVENPORT
210 W BURNSIDE AVE
POCATELLO, ID 83202-4916
Phone number: 208-238-9000
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Mailing Address
ROBERT DAVENPORT
210 W BURNSIDE AVE
POCATELLO, ID 83202-4916
Phone number: 208-590-8259
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